| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DEWITT INSURANCE AGENCY INC | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $101 | $101 | 0.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COVENTRY HEALTH CARE EIN 43-1372307 NONE | Contract Administrator Service code 13 | — | $129K |
| GPB CORPORATION EIN 43-1240518 AFFILIATE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $57K |
| SPECTOR WOLFE MCLAUGHLIN EIN 43-1718339 NONE | Legal Service code 29 | — | $38K |
| ENTERPRISE TRUST EIN 43-1472619 NONE | Custodial (securities) Service code 19 | — | $30K |
| RSM US LLP EIN 42-0714325 NONE | Accounting (including auditing) Service code 10 | — | $22K |
| VISION SERVICE PLAN EIN 43-1471581 NONE | Contract Administrator Service code 13 | — | $9K |
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 | 157 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 126 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 283 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 277 | $20K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $10K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | COVENTRY HEALTH CARE OF MISSOURI | 295 | $171K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 277 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.