| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR STE 200 HUNT VALLEY, MD 21030 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | $0 | $7K | 26.56% |
| THE BENECON GROUP3 Filed as: THE BENECON GROUP, LLC | 201 E OREGON RD STE 100 LITITZ, PA 17543 | UNITEDHEALTHCARE INSURANCE COMPANY | $457 | $0 | $457 | 1.83% |
| HOLLIFIELD PATRICK3 | 300 VESTAVIA PKWY STE 2300 VESTAVIA, AL 35216 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| HOLLIFIELD PATRICK3 | 740 SUSSEX DR VESTAVIA HILLS, AL 35226 | KANSAS CITY LIFE | $3K | $0 | $3K | 19.70% |
| HOLLIFIELD PATRICK3 Filed as: HOLLIFIELD PATRICK T | 300 VESTAVIA PKWY STE 2300 VESTAVIA, AL 35216 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS | 772 LITITZ PIKE LITITZ, PA 17543 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $574 | $0 | $574 | 9.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED PARTNERS (CENTRAL PA) EIN 30-0837157 BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $14K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $4K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 63 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 63 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 32 | $25K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 52 | $6K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 89 | $11K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 89 | $22K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 63 | $238K |
| Other(2 contracts, 2 carriers) | KANSAS CITY LIFE | 89 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 89 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.