Form 5500 · Employee benefit plan · WOMELSDORF, PA
DIEFFENBACHS POTATO CHIPS, INC.
The filing calls this plan DIEFFENBACH'S POTATO CHIPS, INC. GROUP INSURANCE PLAN.
DIEFFENBACHS POTATO CHIPS, INC. of WOMELSDORF, PA is a 123-participant manufacturing employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is PATRIOT GROWTH INSURANCE SVC LLC. Coverage is written through EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-3044270 · plan 502 · plan year 2024, filed Oct 13, 2025
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, dental, vision, life and disability; the largest, with EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA, covers 128 people.
Reported premium across the insured contracts is $168,235, with $12,160 in disclosed broker commissions — about 7.2% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
PATRIOT GROWTH INSURANCE SVC LLC is the broker of record on 3 of the 6 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA, UNITED OF OMAHA LIFE INSURANCE COMPANY, VISION BENEFITS OF AMERICA and REVIVEHEALTH. EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 42 | Jan 1, 2025 | $31,756 | $3,158 |
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Health, Dental | 128 | Jan 1, 2025 | $54,341 | $2,959 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 52 | Jan 1, 2025 | $27,746 | $2,775 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 56 | Jan 1, 2025 | $24,877 | $2,488 |
| VISION BENEFITS OF AMERICA | Vision | 121 | Jan 1, 2025 | $15,600 | $780 |
| REVIVEHEALTH | — | 0 | Jan 1, 2025 | $13,915 | $0 |
Premium and claims on this contract
VISION BENEFITS OF AMERICA, contract 3658. For the contract year on this filing, the carrier reported $15,600 in premium earned and $7,101 in claims incurred. Dividing one by the other gives 46%.
- VISION BENEFITS OF AMERICA, contract 3658 reported $8,499 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 256 employees, 12 recordable cases, 43 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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