| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBCG LLC3 | PO BOX - 1702 RUTHERFORD, NJ 070700702 | METROPOLITAN LIFE INSURANCE COMPANY | $71K | $102K | $173K | 3.30% |
| BUCK CONSULTANTS LLC3 Filed as: BUCK CONSULTANTS LLC - ATLANTA | PO BOX 202617 DALLAS, TX 753202617 | HUMANA HEALTH PLAN, INC. | $157K | — | $157K | 4.96% |
| BUCK CONSULTANTS LLC3 Filed as: BUCK CONSULTANTS, INC | 300 GALLERIA OFFICECENTRE SUITE 500 SOUTHFIELD, MI 48034 | HEALTH ALLIANCE PLAN | $118K | — | $118K | 4.88% |
| BUCK CONSULTANTS LLC3 | 200 BERWYN PARK SUITE 110 BERWYN, PA 19312 | METLIFE - DELAWARE AMERICAN LIFE INSURANCE COMPANY | $51K | — | $51K | 10.83% |
| EBCG LLC3 | PO BOX 1702 RUTHERFORD, NJ 07070 | SUN LIFE ASSURANCE COMPANY OF CANADA | $39K | — | $39K | 18.89% |
| EBCG LLC3 | PO BOX 1702 RUTHERFORD, NJ 07070 | HYATT LEGAL PLANS | $4K | — | $4K | 10.32% |
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 753202617 | HYATT LEGAL PLANS | — | $121 | $121 | 0.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 ADMIN SVC PROVIDER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $3.2M |
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 | 1,942 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,956 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA HEALTH PLAN, INC. | 215 | $3.6M |
| Dental | METLIFE - DELAWARE AMERICAN LIFE INSURANCE COMPANY | 37 | $470K |
| Vision(2 contracts, 2 carriers) | METLIFE - DELAWARE AMERICAN LIFE INSURANCE COMPANY | 4,284 | $684K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 10,488 | $5.8M |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 10,488 | $5.2M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 10,488 | $5.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,488 | — |
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.