| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONI RISK PARTNERS INC3 | 600 E 96TH ST STE 400 INDIANAPOLIS, IN 46420 | HEALTH RESOURCES INC | $10K | $0 | $10K | 10.00% |
| EPIC3 Filed as: EPIC INSURANCE | PO BOX 80159 INDIANAPOLIS, IN 46280 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $0 | $7K | 15.00% |
| EPIC3 Filed as: EPIC INSURANCE | PO BOX 80159 INDIANAPOLIS, IN 46280 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $0 | $6K | 15.00% |
| EPIC3 Filed as: EPIC INSURANCE | PO BOX 80159 INDIANAPOLIS, IN 46280 | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | $4K | $0 | $4K | 15.00% |
| EPIC3 Filed as: EPIC INSURANCE | PO BOX 80159 INDIANAPOLIS, IN 46280 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $472 | $0 | $472 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $53K |
| UMR EIN 39-1995276 ADMIN | Claims processing Service code 12 | — | $48K |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HEALTH RESOURCES INC | 347 | $102K |
| Vision | HEALTH RESOURCES INC | 347 | $102K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 239 | $48K |
| Short-term disability | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 239 | $29K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 119 | $41K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY | 187 | $638K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 239 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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.