| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CANYON RE, LLC3 | 1400 BUFORD HWY, SUITE A-3 BUFORD, GA 30518 | ZURICH AMERICAN INSURANCE COMPANY | $36K | — | $36K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MAGNACARE EIN 11-3410766 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $504K |
| M EGENER EIN 35-0911491 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $105K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $75K |
| INCLUDED HEALTH INC. EIN 45-3580052 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $69K |
| P KEENAN EIN 35-0911491 ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $65K |
| M SCZURKO EIN 35-0911491 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $64K |
| HAGBERG & ASSOCIATES, P.C. EIN 01-0598991 NONE | Legal; Direct payment from the plan Service code 29 | — | $62K |
| MARQUETTE ASSOCIATES EIN 36-3485298 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $55K |
| FOSTER & FOSTER EIN 59-1921114 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $54K |
| J SWIDER EIN 35-0911491 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $43K |
| SAGE ADVISORY SERVICES LTD CO EIN 74-2798841 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $32K |
| OLD NATIONAL BANK EIN 35-1729164 NONE | Custodial (securities); Investment management; Investment management fees paid directly by plan Service code 19 | — | $5K |
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 | 904 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 509 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,413 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC | 678 | $1.8M |
| Vision | VISION SERVICE PLAN | 1,429 | $163K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 984 | $58K |
| Prescription drug | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC | 678 | $1.8M |
| Stop-loss / reinsurancereinsurance | ZURICH AMERICAN INSURANCE COMPANY | 956 | $728K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 984 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,429 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.