| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLLAND INSURANCE, INC.3 | PO BOX 328 SOUTHAVEN, MS 38671 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $194 | $9K | 10.23% |
| HOLLAND INSURANCE, INC.3 | PO BOX 328 SOUTHAVEN, MS 38671 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $133 | $8K | 10.08% |
| HOLLAND INSURANCE, INC.3 | PO BOX 328 SOUTHHAVEN, MS 38671 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $155 | $7K | 10.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF KENTUCKY INC EIN 61-1237516 TPA/NETWORK | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | $261K |
| MEDLINK, INC. | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $63K |
| ANTHEM HEALTH PLANS OF KENTUCY INC EIN 61-1237516 NETWORK PHARM | Other fees Service code 99 | — | $14K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 TPA | Direct payment from the plan; Participant communication; Claims processing; Contract Administrator Service code 12 | — | $9K |
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 | 361 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 361 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 340 | $79K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 361 | $86K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 348 | $67K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 270 | $266K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.