No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PLANNED ADMINISTRATORS INC EIN 50-0718839 TPA ADMINISTRATION | Claims processing Service code 12 | — | $2K |
| INSURANCE APPLICATIONS GROUP EIN 57-1117048 BROKER COMMISSION FEES | Insurance agents and brokers Service code 22 | — | $955 |
| VERISOURCE SERVICES INC. EIN 76-0554001 ENROLLMENT VENDOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $382 |
| FIRST HEALTH EIN 20-1736437 382 | Other insurance fees and expenses Service code 73 | — | $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 | 24 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 24 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | RGI | 24 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 24 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.