| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIRCLE, SUITE 925 ATLANTA, GA 30339 | GREENWICH INSURANCE COMPANY | $12K | — | $12K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATION EIN 39-1400101 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $277K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 39-1365594 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $145K |
| LEE JOST & ASSOCIATES EIN 39-1400101 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | — | $44K |
| SIKICH LLP EIN 36-3168081 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| BMO HARRIS FINANCIAL GROUP EIN 36-2085229 NONE | Trustee (bank, trust company, or similar financial institution); Investment management; Direct payment from the plan; Investment management fees paid directly by plan Service code 21 | — | $16K |
| AURORA EMPLOYER SOLUTIONS EIN 39-1442285 NONE | Other fees Service code 99 | — | $10K |
| US BANK NONE | Direct payment from the plan; Custodial (other than securities) Service code 18 | P.O. BOX 1800 SAINT PAUL, MN 551010800 | $7K |
| OPTUM HEALTH CARE SOLUTIONS, LLC EIN 41-1591944 NONE | Other fees Service code 99 | 11000 OPTUM CIRCLE, MN 101 - W400 EDEN PRAIRIE, MN 55344 | $7K |
| WEX HEALTH, INC. EIN 06-1593514 NONE | Claims processing; Direct payment from the plan Service code 12 | 82 HOPMEADOW STREET, SUITE 220 SIMSBURY, CT 06089 | $6K |
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 | 373 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 107 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | GREENWICH INSURANCE COMPANY | 406 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.