| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $22K | — | $22K | 5.23% |
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | — | $15K | 5.20% |
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $142 | — | $142 | 5.24% |
| BUCK CONSULTANTS LLC2 | PO BOX 202617 DALLAS, TX 75320 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $72 | — | $72 | 5.24% |
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $665 | — | $665 | 2660.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA LIFE AND HEALTH INSURANCE CO EIN 59-1031071 MEDICAL ADMINISTRATION | Other services; Float revenue; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation Service code 12 | — | $830K |
| UNITED CONCORDIA EIN 25-1687586 DENTAL ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $49K |
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 | 1,186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KEYSTONE | 30 | $374K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,186 | $427K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 470 | $294K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,186 | $430K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,186 | — |
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.