| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARTIN R. MIRACLE3 Filed as: MARTIN R MIRACLE | 9811 KATY FREEWAY #500 HOUSTON, TX 77024 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST INC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $436 | $436 | 3.89% |
| MARTIN R. MIRACLE3 Filed as: MARTIN R MIRACLE | 9811 KATY FREEWAY #500 HOUSTON, TX 77024 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $566 | $0 | $566 | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST INC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $221 | $221 | 3.91% |
| MARTIN R. MIRACLE3 | 13926 MAPLE CLIFF LANE CYPRESS, TX 77429 | NATIONAL VISION ADMINISTRATORS, LLC (NGL) | $531 | $0 | $531 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| YORK HEALTH PLAN EIN 23-2664989 ADMIN | Claims processing Service code 12 | — | $33K |
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 ADMIN | Claims processing Service code 12 | — | $5K |
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL VISION ADMINISTRATORS, LLC (NGL) | 175 | $5K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 100 | $6K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 100 | $11K |
| Stop-loss / reinsurancereinsurance | CAPITAL ADVANTAGE ASSURANCE COMPANY | 85 | $169K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 100 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.