| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 N. 40TH ST., STE 234 PHOENIX, AZ 85018 | AMERICAN FIDELITY ASSURANCE COMPANY | $15K | — | $15K | 3.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 NONE | Direct payment from the plan; Contract Administrator; Plan Administrator; Other services; Participant communication; Consulting (general) Service code 13 | — | $117K |
| GREAT WEST HEALTHCARE/CIGNA EIN 84-0467907 NONE | Consulting (general); Contract Administrator; Direct payment from the plan; Other services; Participant communication; Plan Administrator Service code 13 | — | $69K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Consulting (general); Participant communication; Plan Administrator; Other services; Contract Administrator; Direct payment from the plan Service code 13 | — | $45K |
| ROGERS BENEFIT GROUP, INC. EIN 41-1596522 NONE | Plan Administrator; Contract Administrator; Direct payment from the plan; Participant communication; Consulting (general); Other services Service code 13 | — | $3K |
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 | 312 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN FIDELITY ASSURANCE COMPANY | 312 | $425K |
| Prescription drug | AMERICAN FIDELITY ASSURANCE COMPANY | 312 | $425K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.