| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARY WHITT COBALT BENEFITS, INC.3 Filed as: MARY E. WHITT COBALT BENEFITS, INC. | 22615 STATE ROAD 120 ELKHART, IN 465165369 | HCC LIFE INSURANCE COMPANY | $33K | $0 | $33K | 10.00% |
| ASSUREDPARTNERS5 Filed as: PROFESSIONAL BENFIT ADMINISTRATORS | 901 JORIE BLVD, STE. 250 OAK BROOK, IL 60523 | HCC LIFE INSURANCE COMPANY | $16K | — | $16K | 5.00% |
| MARY WHITT COBALT BENEFITS, INC.3 Filed as: MARY E WHITT COBALT BENEFITS, INC | 22615 STATE ROAD 120 ELKHART, IN 465165369 | DELTA DENTAL OF INDIANA | $5K | $0 | $5K | 5.94% |
| MARY WHITT COBALT BENEFITS, INC.3 Filed as: MARY E WHITT COBALT BENEFITS, INC. | 22615 STATE ROAD 120 ELKHART, IN 465165369 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.37% |
| MARY WHITT COBALT BENEFITS, INC.3 | 22615 STATE ROAD 120 ELKHART, IN 465165369 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS EIN 36-3384135 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | 901 JORIE BLVD, STE. 250 OAK BROOK, IL 60523 | $0 |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 115 | $327K |
| Dental | DELTA DENTAL OF INDIANA | 115 | $78K |
| Vision | VISION SERVICE PLAN | 115 | $22K |
| Prescription drug | HCC LIFE INSURANCE COMPANY | 115 | $327K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 115 | $327K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 115 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.