| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BUSINESS INSURANCE AGENCY3 Filed as: BUSINESS BENEFITS INC | 211 GRANDVIEW DR STE 307 FT MITCHELL, KY 410172726 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 3.29% |
| BUSINESS INSURANCE AGENCY3 Filed as: BUSINESS BENEFITS, INC. | 211 GRANDVIEW DR., STE 307 FT. MITCHELL, KY 410172726 | AMERICAN UNITED LIFE INSURANCE CO. | $15K | $7K | $22K | 16.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY (G1728) EIN 31-1440175 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Other services; Contract Administrator; Float revenue Service code 12 | — | $161K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 NONE | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $50K |
| BUSINESS BENEFITS, INC. EIN 31-1440175 NONE | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $35K |
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 | 559 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 559 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $164K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $299K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $299K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $299K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 292 | $261K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $299K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 559 | — |
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.