| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HJ KNIGHT INTERNATIONAL3 | 30 BRAINTREE HILL OFFICE PARK, STE BRAINTREE, MA 02184 | HCC LIFE INSURANCE COMPANY | $2K | — | $2K | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTH CARE INSURANCE CO. EIN 36-2739571 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $169K |
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1400101 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $138K |
| UMR EIN 36-2739571 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $28K |
| ZELIS HEALTHCARE EIN 86-1040704 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $21K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $18K |
| SVA CERTIFIED PUBLIC ACCOUNTANTS, S EIN 39-1203191 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $15K |
| THE PREVIANT LAW FIRM, S.C. EIN 39-1211596 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| USBANK N.A. EIN 86-0441303 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $8K |
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 | 376 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 385 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 376 | $420K |
| Life insurance | HCC LIFE INSURANCE COMPANY | 376 | $420K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 376 | $420K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 376 | — |
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.