| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRANSAMERICA5 | 4333 EDGEWOOD ROAD, NE CEDAR RAPIDS, IA 52499 | TRANSAMERICA PREMIER | — | $72K | $72K | — |
| SISCO5 | 600 MAIN STREET DUBUQUE, IA 52001 | TRANSAMERICA PREMIER | — | $46K | $46K | — |
| SUMMIT FINANCIAL GROUP INC.3 Filed as: SUMMIT FINANCIAL | 11350 MCCORMICK ROAD, SUITE 501 EXECUTIVE PLAZA III HUNT VALLEY, MD 21031 | TRANSAMERICA PREMIER | $23K | — | $23K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT INDEMNITY CORP. EIN 66-0761417 INDEMNITY COVERAGE | Contract Administrator Service code 13 | — | $66K |
| SISCO EIN 42-1144827 3RD PARTY ADMIN | Contract Administrator Service code 13 | — | $46K |
| CIGNAGREAT WEST HEALTH EIN 84-0467907 PREF. PROVIDER NETWORK | Contract Administrator Service code 13 | — | $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 | 134 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | TRANSAMERICA PREMIER | 134 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 134 | — |
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.