| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS BLUE SHIELD | 2301 MAIN STREET KANSAS CITY, MO 64108 | BLUE CROSS BLUE SHIELD (STOP LOSS ONLY) | $0 | $370K | $370K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF KC EIN 43-1257251 PROVIDER NET | Claims processing; Direct payment from the plan; Other services Service code 12 | — | $1.9M |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 CONTRACT ADMIN | Accounting (including auditing); Contract Administrator; Direct payment from the plan Service code 10 | — | $714K |
| LDI INTERGRATED PHARMACY SERVICES EIN 43-0912223 PRESCRIPTION SERVICES | Claims processing; Direct payment from the plan Service code 12 | — | $161K |
| ARNOLD, NEWBOLD, WINTER & JACKSON EIN 43-1174269 LEGAL | Legal; Direct payment from the plan Service code 29 | — | $150K |
| BARROW, HANLEY, MEWHINNEY, STRAUSS EIN 75-2403190 INVESTMENT MGMT | Investment management fees paid directly by plan; Investment management; Soft dollars commissions Service code 28 | — | $119K |
| COMMERCE TRUST EIN 48-0962626 INVESTMENT MANAGER | Investment management; Investment management fees paid directly by plan Service code 28 | — | $87K |
| ULLICO EIN 13-1423090 INVESTMENT MANAGER | Investment management; Investment management fees paid directly by plan Service code 28 | — | $65K |
| PREFERRED HEALTH PROFESSIONALS EIN 43-1392960 PROVIDER NET | Direct payment from the plan; Other services; Claims processing Service code 12 | — | $61K |
| UNITED ACTUARIAL SERVICES EIN 35-2156428 ACTUARIAL SERVICES | Actuarial; Direct payment from the plan; Consulting fees; Consulting (general) Service code 11 | — | $55K |
| LEES PRINTING EIN 48-0924320 PRINTERS | Direct payment from the plan; Other services Service code 49 | — | $41K |
| FIDICIARY CONSULTANTS EIN 43-1489435 INVESTMENT CONSULTING | Direct payment from the plan; Investment advisory (plan); Consulting fees Service code 27 | — | $41K |
| CUNEO, LAWSON, SHAY, & STALEY CPAS EIN 44-0642126 AUDITORS | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $37K |
| COMMERCE BANK EIN 48-0962626 INVESTMENT CUSTODIAN | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $27K |
| HUBER & ASSOCIATES EIN 43-1516109 SOFTWARE SUPPORT | Direct payment from the plan; Other services Service code 49 | — | $22K |
| TRADE SOLUTIONS EIN 59-3821105 PRINTING/STORAGE | Other services; Direct payment from the plan Service code 49 | — | $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 | 3,869 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,621 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,490 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD (STOP LOSS ONLY) | 11,657 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,657 | — |
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.