| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED GROUP BROKERAGE CORP.3 | 369 NORTH MAIN STREET MARLBOROUGH, CT 064470299 | TOKIO MARINE HCC | $305 | — | $305 | 3.00% |
| DIVERSIFIED GROUP BROKERAGE CORP.3 | 369 NORTH MAIN STREET MARLBOROUGH, CT 06447 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 25.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIVERSIFIED ADMINISTRATION CORP. EIN 06-0988547 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 369 NORTH MAIN STREET MARLBOROUGH, CT 06447 | $108K |
| CORPORATE MANAGED HEALTH SERVICES EIN 06-1421429 CASE MANAGEMENT | Contract Administrator Service code 13 | 369 NORTH MAIN STREET MARLBOROUGH, CT 06447 | $0 |
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $9K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 69 | $231K |
| Other(2 contracts, 2 carriers) | TOKIO MARINE HCC | 170 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.