| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS | 11440 TOMAHAWK CREEK PKWY LEAWOODM, KS 66211 | BLUE CROSS BLUE SHIELD OF KANSAS CITY | $60K | $60K | $120K | 3.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $2K | $13K | 4.03% |
| CRETCHER HEARTLAND LLC3 | 3RD FLOOR 4551 W 107TH STREET OVERLAND PARK, KS 66207 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.75% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC | 99 TROY ROAD EAST GREENBUSH, NY 12061 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.67% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $140 | $140 | 0.04% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC | 99 TROY ROAD EAST GREENBUSH, NY 12061 | VISION SERVICE PLAN | $1K | — | $1K | 1.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Claims processing; Contract Administrator Service code 12 | 12399 GRAVOIS ROAD ST. LOUIS, MO 63127 | $39K |
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 | 422 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 422 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF KANSAS CITY | 1,067 | $3.9M |
| Vision | VISION SERVICE PLAN | 415 | $63K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 422 | $333K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 422 | $333K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 422 | $333K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 422 | $333K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,067 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.