| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TODD HENDRICKS3 | WILLIS OF ILLINOIS INC. 233 S WACKER DRIVE, SUITE 2000 CHICAGO, IL 60606 | BLUE CROSS AND BLUE SHIELD OF KANSAS | $45K | — | $45K | 4.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOISINC | PO BOX 93225 CHICAGO, IL 60673 | TRANSAMERICA LIFE INSURANCE COMPANY | $76K | — | $76K | 68.75% |
| PFS INSURANCE GROUP LLC3 Filed as: PFS INSURANCE GROUPLLC | 4848 THOMPSON PKWY, STE 200 JOHNSTOWN, CO 80534 | TRANSAMERICA LIFE INSURANCE COMPANY | $112 | — | $112 | 0.10% |
| PARAGON PARTNERS LTD3 Filed as: PARAGON PARTNERS LIMITED | 9420 E DOUBLETREE RANCH RD STE C-103 SCOTTSDALE, AZ 85258 | TRANSAMERICA LIFE INSURANCE COMPANY | $37 | — | $37 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS | 233 SOUTH WACKER DRIVE CHICAGO, IL 60606 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | — | $4K | 16.13% |
| INNOBENEFITS LLC3 | 1280 BRIGHTON WAY NEW TOWN SQUARE, PA 19073 | TRANSAMERICA LIFE INSURANCE COMPANY | $779 | — | $779 | 2.91% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC. | 233 S WACKER STE 2000 CHICAGO, IL 60606 | ADVANCE INSURANCE COMPANY OF KANSAS | $3K | — | $3K | 14.05% |
| LOWREY, DEBORA J3 | DIVERSIFIED BENEFIT SVCS PO BOX 1987 FRISCO, TX 75034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 CLAIMS PROCESSOR | Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Account maintenance fees; Claims processing Service code 12 | — | $56K |
| WILLIS OF ILLINOIS EIN 36-2691200 BROKER | Insurance brokerage commissions and fees; Real estate brokerage Service code 32 | — | $26K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 INSURANCE ELAP | Insurance services; Insurance brokerage commissions and fees Service code 23 | — | $14K |
| INNOBENEFITS LLC EIN 22-6943343 RECORDKEEPER | Insurance brokerage commissions and fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $11K |
| MULTIPLAN EIN 35-2048379 INSURANCE NETWORK | Insurance services; Insurance brokerage commissions and fees Service code 23 | — | $6K |
| RGI, LLC EIN 32-0176370 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance brokerage commissions and fees Service code 15 | — | $6K |
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 | 694 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 694 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF KANSAS | 194 | $900K |
| Dental | BLUE CROSS AND BLUE SHIELD OF KANSAS | 194 | $900K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 384 | $31K |
| Life insurance(5 contracts, 4 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 694 | $186K |
| Short-term disability | TRANSAMERICA LIFE INSURANCE COMPANY | 75 | $27K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 23 | $9K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF KANSAS | 194 | $900K |
| Other(4 contracts, 3 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 694 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 694 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.