No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY (G1728) EIN 31-1440175 | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing Service code 12 | — | $91K |
| BENESYS, INC. EIN 38-2383170 | Contract Administrator Service code 13 | — | $68K |
| THE SEGAL COMPANY EIN 13-1975125 | Consulting (general) Service code 16 | — | $46K |
| FAULKNER, HOFFMAN & PHILLIPS, LLC. EIN 34-1909706 | Legal Service code 29 | — | $11K |
| CIUNI & PANICHI, INC. EIN 34-1322309 | Accounting (including auditing) Service code 10 | — | $11K |
| FIFTH THIRD BANK EIN 31-1051736 | Investment management Service code 28 | — | $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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 148 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTHSPAN INTEGRATED CARE | 24 | $98K |
| Prescription drug(2 contracts, 2 carriers) | HEALTHSPAN INTEGRATED CARE | 24 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 24 | — |
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.