| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANIEL LAPE3 | MITCHELL INSURANCE 901 N MAIN P O BOX 10 SIKESTON, MO 63801 | AVERA HEALTH PLANS INC | $53K | — | $53K | 2.95% |
| MITCHELL INSURANCE INC3 | 901 N MAIN STREET SIKESTON, MO 63801 | PRINCIPAL LIFE INSURANCE COMPANY | $30K | $10K | $39K | 9.22% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | P O BOX 70 WEST POINT, GA 31833 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $999 | $3K | 0.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AVERA HEALTH PLANS CLAIMS ADMIN | Claims processing; Plan Administrator; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 5300 S BROADBAND LANE SIOUX FALLS, SD 57108 | $3K |
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 | 267 | 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) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AVERA HEALTH PLANS INC | 514 | $1.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 614 | $428K |
| Vision(2 contracts, 2 carriers) | AVERA HEALTH PLANS INC | 614 | $2.2M |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 614 | $428K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 614 | $428K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 614 | $428K |
| Prescription drug | AVERA HEALTH PLANS INC | 514 | $1.8M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 614 | $428K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 614 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.