| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS- SEE ATTACHED LISTING | PO BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $20K | — | $20K | 17.38% |
| ENROLLEASE3 Filed as: DIGITAL INSURANCE INC DBA NWEST BEN | 200 GALLERIA PARKWAY SE STE 1950 ATLANTA, GA 303395946 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $5K | $12K | 16.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIGITAL INSURANCE INC EIN 58-2522688 BROKER | Other commissions Service code 55 | — | $96K |
| ALLIED BENEFITS SYSTEMS EIN 36-3086057 TPA | Contract Administrator; Claims processing Service code 12 | — | $74K |
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 | 300 | 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) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 237 | $1.1M |
| Dental | AETNA LIFE INSURANCE COMPANY | 237 | $1.1M |
| Vision | AETNA LIFE INSURANCE COMPANY | 237 | $1.1M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $75K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $75K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $75K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 1 | $13K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION (ALLIED) | 126 | $462K |
| Other(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | 312 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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.