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| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSCOPE EIN 71-0847266 ADMINISTRATOR | Contract Administrator; Account maintenance fees; Other services; Recordkeeping fees; Other fees; Claims processing Service code 12 | — | $232K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Claims processing; Contract Administrator Service code 12 | — | $27K |
| UNITED OF OMAHA LIFE INSURANCE COMP EIN 47-0322111 NONE | Claims processing; Contract Administrator Service code 12 | — | $11K |
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 | 480 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 353 | $40K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 480 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 480 | $42K |
| Stop-loss / reinsurancereinsurance | GROSVENOR BROKERS | 273 | $438K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 480 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 480 | — |
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.