| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INS INC | 200 GALLERIA PKWY SE SUITE 1950 ATLANTA, GA 30339 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 14.26% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | AETNA | $4K | — | $4K | 4.03% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | PO BOX 8950 MADISON, WI 53708 | TRANSAMERICA LIFE INSURANCE COMPANY | $12K | — | $12K | 22.96% |
| MITCH BESVINICK3 | 1280 BRIGHTON WAY NEW TOWN SQUARE, PA 19073 | TRANSAMERICA LIFE INSURANCE COMPANY | $221 | — | $221 | 0.43% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | BLUE CROSS BLUE SHIELD OF TEXAS | $1K | — | $1K | 2.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN LONE STAR INS SERVICE | 1717 N SAM HOUSTON PKWY W STE 115 HOUSTON, TX 77038 | BLUE CROSS BLUE SHIELD OF TEXAS | $506 | $18 | $524 | 1.41% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 801 E PINE ST STE 650 ORLANDO, FL 32801 | TLIC | $16K | — | $16K | 64.17% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PKWY SE STE 300 ATLANTA, GA 30339 | PAN AMERICAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN LONE STAR INS SERVICE | 1717 N SAM HOUSTON PKWY W STE 115 HOUSTON, TX 770381325 | UNITED HEALTHCARE INSURANCE COMPANY | $296 | — | $296 | 4.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS INC EIN 35-1450364 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $65K |
| DIGITAL INSURANCE INC EIN 58-2522668 INSURANCE BROKER | Insurance agents and brokers Service code 22 | PO BOX 8950 MADISON, WI 53708 | $43K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 INSURANCE SERVICES | Insurance services Service code 23 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $12K |
| MULTIPLAN EIN 35-2048379 INSURANCE SERVICES | Insurance services Service code 23 | 115 5TH AVENUE 7TH FLOOR NEW YORK, NY 10003 | $10K |
| MITCH BESVINICK INSURANCE BROKER | Insurance agents and brokers Service code 22 | 1280 BRIGHTON WAY NEW TOWN SQUARE, PA 19073 | $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 | 299 | 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) | 299 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | AETNA | 159 | $171K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $104K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $104K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $104K |
| Short-term disability | TLIC | 250 | $25K |
| Stop-loss / reinsurancereinsurance | PAN AMERICAN LIFE INSURANCE COMPANY | 159 | $16K |
| Other(3 contracts, 3 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 299 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.