| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS SERVS OF THE WEST | 9200 SHELBYVILLE RD LOUISVILLE, KY 40222 | HUMANA | $26K | — | $26K | 3.64% |
| UMR, INC.5 Filed as: UMR | 11 SCOTT STREEET STE 100 WAUSAU, WI 54403 | ULLICO | — | $10K | $10K | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR EIN 39-1995276 NONE | Claims processing; Contract Administrator Service code 12 | 333 WEST VINE STREET LEXINGTON, KY 40507 | $242K |
| STRATEGIC CAPITAL PARTNERS LLC NONE | Investment advisory (plan) Service code 27 | 230 W. MONROE ST. STE 250 CHICAGO, IL 60606 | $37K |
| PAMELA POTTER EIN 26-4310632 NONE | Employee (plan) Service code 30 | 312 MAIN STREET ELKORN CITY, KY 41522 | $24K |
| HERZFELD SUETHOLZ GASTEL LENISKI NONE | Legal Service code 29 | 600 VINE STREET STE 2720 CINCINNATI, OH 45202 | $17K |
| FRANK N HESTAND CPA PSC EIN 61-1336870 NONE | Accounting (including auditing) Service code 10 | 261 REGENCY CIRCLE LEXINGTON, KY 40503 | $9K |
| LORI P THORNSBERRY NONE | Employee (plan) Service code 30 | 312 MAIN STREET ELKORN CITY, KY 41522 | $7K |
| CONSULTING AND RISK MANAGEMENT INC EIN 61-1317950 NONE | Consulting (general) Service code 16 | 220 HERITAGE RD VERSAILLES, KY 40383 | $6K |
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 | 225 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 239 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 464 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | ULLICO | 250 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.