| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AGIS NETWORK INC3 | 2122 KRATKY ROAD SAINT LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 9.96% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE SUITE 1950 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 4.98% |
| CORPORATE HEALTH SYSTEMS INC3 | 15153 TECHNOLOGY DRIVE SUITE B EDEN PRAIRIE, MN 55344 | HARTFORD LIFE AND ACCIDENT | $20K | — | $20K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREFERREDONE ADMINISTRATIVE SERVICE EIN 41-1846481 ASO HLTH | Non-monetary compensation; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication; Direct payment from the plan; Claims processing; Contract Administrator; Other services Service code 12 | — | $71K |
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 | 290 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 294 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREFERRED ONE INSURANCE COMPANY | 550 | $0 |
| Dental | DDMN ASO, LLC (DELTA DENTAL) | 566 | $188K |
| Vision | EYEMED VISION CARE | 292 | $12K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 290 | $130K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 290 | $130K |
| Stop-loss / reinsurancereinsurance | PREFERRED ONE INSURANCE COMPANY | 550 | $0 |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 290 | $267K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 566 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.