| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREG STOCKSDALE3 | P.O. BOX 32 URBANA, OH 43078 | AMERICAN UNITED LIFE INSURANCE COMPANY | $7K | — | $7K | 8.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLASCAK INSURANCE SERVICES LLC EIN 47-1663993 NONE | Insurance agents and brokers Service code 22 | — | $89K |
| BENEFIT PLAN ADMINISTRATORS, INC. EIN 54-1419753 NONE | Claims processing Service code 12 | — | $66K |
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 NONE | Contract Administrator Service code 13 | — | $62K |
| MAX BENEFITS LLC EIN 83-4442613 NONE | Contract Administrator Service code 13 | — | $26K |
| INETICO LLC NONE | Contract Administrator Service code 13 | 4913 W LAUREL ST., STE. A TAMPA, FL 33607 | $20K |
| INTERFACE EAP NONE | Contract Administrator Service code 13 | P.O. BOX 421879 HOUSTON, TX 77242 | $6K |
| THE PHIA GROUP, LLC NONE | Contract Administrator Service code 13 | 163 BAY STATE DR. BRAINTREE, MA 02184 | $4K |
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 | 374 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 375 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 557 | $79K |
| Prescription drug | UNITED STATES FIRE INSURANCE COMPANY | 815 | $585K |
| Stop-loss / reinsurancereinsurance | UNITED STATES FIRE INSURANCE COMPANY | 815 | $585K |
| Other | AMERICAN UNITED LIFE INSURANCE COMPANY | 557 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 815 | — |
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.