| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT E. MILLER INSURANCE AGENCY3 | 373 WEST 104TH TERR, SUITE 200 KANSAS CITY, MO 64114 | BLUECROSS BLUESHIELD OF KANSAS CITY | $82K | $18K | $100K | 4.06% |
| ROBERT E. MILLER INSURANCE AGENCY3 | 6363 COLLEGE BOULEVARD, SUITE 400 OVERLAND PARK, KS 66211 | METROPOLITAN LIFE INSURANCE COMPANY | $18K | — | $18K | 9.91% |
| ROBERT E. MILLER INSURANCE AGENCY3 | 6363 COLLEGE BOULEVARD, SUITE 400 OVERLAND PARK, KS 66211 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 6.18% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE, STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $77 | $77 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NEW DIRECTIONS BEHAVIORAL HEALTH EIN 43-1698690 EAP ADMINISTRATOR | Contract Administrator Service code 13 | — | $17K |
| PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 STD ADMINISTRATOR | Contract Administrator Service code 13 | — | $9K |
| DISCOVERY BENEFITS EIN 90-0058554 COBRA & FSA ADMINISTRATOR | Contract Administrator Service code 13 | — | $7K |
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 | 187 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF KANSAS CITY | 426 | $2.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 442 | $180K |
| Vision | VISION SERVICE PLAN | 128 | $24K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 218 | $144K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 218 | $144K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 218 | $144K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 442 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.