| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HCC LIFE INSURANCE COMPANY | $37K | — | $37K | 4.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ORSCHELN MANAGEMENT CO. EIN 43-1465246 AFFILIATED PARTICIPATING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator Service code 14 | — | $113K |
| HEALTHSCOPE BENEFITS, INC. EIN 71-0847266 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $99K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $66K |
| LOCKTON COMPANIES, LLC EIN 20-3354970 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| WILLIAMS-KEEPERS, LLC EIN 43-1126847 AUDITOR | Accounting (including auditing) Service code 10 | — | $19K |
| AMERICAN HEALTH HOLDING, INC. EIN 31-1368946 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| MAXCARE RX EIN 47-1448249 CONTRACT ADMINISTRATOR | Other services; Contract Administrator Service code 13 | — | $16K |
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 | 340 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 342 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 340 | $733K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 340 | — |
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.