| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY ATLANTA, GA 30339 | DELTA DENTAL OF MISSOURI | $13K | $1K | $14K | 10.82% |
| DIGITAL INSURANCE LLC3 | 300 GALLERIA PKWY SE STE 1100 ATLANTA, GA 30339 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $0 | $4K | 13.28% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE STE 1950 ATLANTA, GA 30339 | ADVANTICA INSURANCE COMPANY | $2K | $208 | $2K | 10.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SHOW-ME HEALTH ADMINISTRATORS LLC OTHER | Other services Service code 49 | 2861 MEADOWBROOK AVE STE 200 SPRINGFIELD, MO 65807 | $114K |
| ONEDIGITAL EIN 58-2522668 BROKER | Insurance agents and brokers Service code 22 | — | $110K |
| CIGNA PPO NETWORK | Claims processing Service code 12 | 900 COTTAGE GROVE RD BLOOMFIELD, CT 06152 | $60K |
| VALENZ CARE UTILIZATION REVIEW SERVI | Other services Service code 49 | 100 MATSONFORD RD #5-444 WAYNE, PA 19087 | $20K |
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 | 324 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | 416 | $467K |
| Dental | DELTA DENTAL OF MISSOURI | 414 | $134K |
| Vision | ADVANTICA INSURANCE COMPANY | 336 | $22K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,079 | $29K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 1,079 | $29K |
| Other | H & H HEALTH ASSOCIATES INC | 0 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,079 | — |
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.