| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC5 Filed as: KEY BENEFIT ADMINISTRATORS, INC. | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | HCC LIFE INSURANCE | $31K | — | $31K | 10.00% |
| CLIPPINGER FINANCIAL GROUP LLC3 | 415 CROSSLAKE DR # A EVANSVILLE, IN 47715 | VISION SERVICE PLAN | $5K | — | $5K | 1.89% |
| SCOTT CLIPPINGER3 | 415 CROSSLAKE DR STE A EVANSVILLE, IN 47715 | DENTAL HEALTH OPTIONS | $11K | — | $11K | 16.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $480K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $185K |
| CIGNA EIN 06-0303370 NONE | Contract Administrator Service code 13 | P.O. BOX 645014 CINCINNATI, OH 45264 | $109K |
| ENCORE EIN 35-2067373 NONE | Contract Administrator Service code 13 | 7224 SOLUTION CENTER CHICAGO, IL 60677 | $102K |
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 | 1,755 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,764 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | RELIASTAR LIFE INSURANCE | 1,764 | $1.3M |
| Dental | DENTAL HEALTH OPTIONS | 1,776 | $64K |
| Vision | VISION SERVICE PLAN | 1,552 | $244K |
| Other | HCC LIFE INSURANCE | 1,764 | $307K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,776 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.