| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OOSI3 | 1 NW OOIDA DRIVE GRAIN VALLEY, MO 64029 | PURITAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 25.12% |
| BRUCE WELNER3 | 818 BARE BRANCH AVENUE LAS VEGAS, NV 89123 | PURITAN LIFE INSURANCE COMPANY OF AMERICA | $286 | — | $286 | 5.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MED-PAY, INC. EIN 43-1318969 NONE | Contract Administrator Service code 13 | PO BOX 10909 SPRINGFIELD, MO 65808 | $62K |
| PREFERRED HEALTH PROFESSIONAL EIN 20-1665464 NONE | Direct payment from the plan Service code 50 | 9393 W 110TH STE 200 OVERLAND PARK, KS 66210 | $53K |
| UCS HOLDINGS. INC. EIN 81-5149270 NONE | Direct payment from the plan Service code 50 | 23048 N 15TH AVE PHOENIX, AZ 85027 | $204 |
| NOVA NET EIN 58-2106226 NONE | Other fees Service code 99 | 3500 PARKWAY LANE SUITE 440 NORCROSS, GA 30092 | $46 |
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 | 263 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PURITAN LIFE INSURANCE COMPANY OF AMERICA | 263 | $6K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 263 | $579K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 263 | — |
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.