| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 15.15% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | GUARDIAN | $2K | $0 | $2K | 23.10% |
| NATIONAL BENEFIT CENTER3 | 1105 NORTH MARKET ST SUITE 1300 WILMINGTON, DE 19801 | GUARDIAN | $12 | $0 | $12 | 0.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE BENEFIT ADMINISTRATORS OF MA EIN 31-1432329 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $66K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 BROKER/CONSULTANT | Consulting (general) Service code 16 | — | $41K |
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 | 91 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 91 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 111 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $45K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $45K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $45K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE | 0 | $292K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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."
No prospect flags tripped on this filing.