| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RISK & INSURANCE CONSULTING SERVICE3 | 5500 LILBURN STONE MOUNTAIN RD STE STONE MOUNTAIN, GA 30087 | HCC LIFE INSURANCE COMPANY | $5K | — | $5K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL CFR | 5314 S YALE AVE, STE 900 TULSA, OK 74135 | DELTA DENTAL | $4K | — | $4K | 4.08% |
| THE HOLMES ORGANISATION3 Filed as: THE HOLMES ORGANISATION INC | PO BOX 1440 TULSA, OK 741011440 | DELTA DENTAL | $4K | — | $4K | 3.93% |
| THE HOLMES ORGANISATION3 Filed as: HOLMES ORGANISATION INC | PO BOX 1440 TULSA, OK 741011440 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 22.22% |
| PLAN BENEFIT ANALYSTS OF TULSA INC3 Filed as: PLAN BENE ANALYSTS OF TULSA INC | 4775 EAST 91ST ST SUITE 200 TULSA, OK 74137 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 22.16% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $74 | $74 | 0.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 844501 DALLAS, TX 75284 | VISION SERVICE PLAN | $781 | — | $781 | 3.17% |
| THE HOLMES ORGANISATION3 Filed as: THE HOLMES ORGANISATION, INC | 1350 S BOULDER AVE STE 1000 TULSA, OK 741193223 | VISION SERVICE PLAN | $493 | — | $493 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL EIN 23-7322578 NONE | Contract Administrator Service code 13 | — | $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 | 212 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 161 | $275K |
| Dental | DELTA DENTAL | 168 | $109K |
| Vision | VISION SERVICE PLAN | 141 | $25K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $23K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 213 | $48K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 147 | $27K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 212 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.