| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 303395946 | UNITEDHEALTHCARE INSURANCE COMPANY | $64K | — | $64K | 3.75% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $7K | $12K | 9.10% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 N KIRKWOOD ROAD SUITE 300 KIRKWOOD, MO 63122 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.00% |
| RUGGIERI, PHILIP3 | C/O RUGGIERI CONSULTING 355 LEXINGTON AVE 22ND FL NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | $8K | — | $8K | 8.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EB EMPLOYEE SOLUTIONS, LLC NONE | Claims processing; Contract Administrator Service code 12 | BOX #791293 BALTIMORE, MD 212791293 | $45K |
| MAVEN CLINIC CO. EIN 46-5747423 NONE | Direct payment from the plan; Other services Service code 49 | — | $10K |
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 | 114 | 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. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 202 | $1.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $130K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $130K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 114 | $84K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 114 | $84K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 114 | $84K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 114 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.