| 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 | $0 | $5K | 11.95% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 3.22% |
| CLARK INSURANCE3 Filed as: CLARK & LAVEY BENEFITS SOLUTIONS | 7 HENRY CLAY DRIVE MERRIMACK, NH 03054 | GUARDIAN | $2K | $0 | $2K | 23.10% |
| R FINE & R FINE INS LLC3 | 370 MAIN ST STE 1025 WORCESTER, MA 01608 | GUARDIAN | $18 | $0 | $18 | 0.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH PLANS INC EIN 04-2734278 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $47K |
| CLARK & LAVEY BENEFITS SOLUTIONS EIN 04-3348257 BROKER/CONSULTANT | Consulting (general) Service code 16 | — | $31K |
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 | 67 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 67 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 85 | $8K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $39K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $39K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $39K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 67 | $157K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.