| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS GEORGE KEELER3 Filed as: DOUGLAS KEELER | C/O KEELER ASSOCIATES 2209 1ST AVE PLATTSMOUTH, NE 68048 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $746 | — | $746 | 2.46% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES OF KANSAS CITY | PO BOX 410249 KANSAS CITY, MO 64141 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $525 | — | $525 | 1.73% |
| MARC ALAN HOLLABAUGH3 Filed as: MARC A HOLLABAUGH | 6701 W 64TH ST STE 312 OVERLAND PARK, KS 66202 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $180 | — | $180 | 0.59% |
| DOUGLAS R PEETE3 | 4551 W 107TH ST STE 220 OVERLAND PARK, KS 66207 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $128 | — | $128 | 0.42% |
| RALPH H KEELER3 | 8716 RIVERDALE RD PLATTSMOUTH, NE 68048 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.22% |
| JAMES P MULLINIX3 | 580 LAKESHORE DR W LAKE QUIVIRA, KS 66217 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.06% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $7 | $7 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | IDS CENTER 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $1K | $1K | 5.01% |
No Schedule C service providers reported on this filing.
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 | 257 | 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) | 257 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 257 | $54K |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 257 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.