| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PETRICH BENEFIT PLAN SERVICES, INC.3 Filed as: PETRICH BENEFIT PLAN SERVICES INC | 345 N RIVERVIEW STE 600 WICHITA, KS 67203 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 13.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $121 | $121 | 0.14% |
| JAMES R PETRICH3 | PETRICH BENEFIT PLAN SVCS 345 N RIVERVEIW SUITE 600 WICHITA, KS 67203 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 17.00% |
| PETRICH BENEFIT PLAN SERVICES, INC.3 Filed as: PETRICH BENEFIT PLAN SERVICES | 345 N RIVERVIEW STE 600 WICHITA, KS 67203 | UNUM LIFE INSURANCE COMPANY | $4K | — | $4K | 15.43% |
| THE MILLER GROUP3 | — | SURENCY LIFE AND HEALTH | $478 | — | $478 | 3.32% |
| PETRICH BENEFIT PLAN SERVICES, INC.3 | 345 N. RIVERVIEW, SUITE 600 WICHITA, KS 67203 | ZURICH AMERICAN INSURANCE COMPANY | $470 | — | $470 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLEN, GIBBS & HOULIK, LC EIN 48-1032601 AUDITOR | Accounting (including auditing) Service code 10 | 301 NORTH MAIN STE 1700 WICHITA, KS 67202 | $0 |
| BENEFIT MANAGEMENT LLC EIN 48-1168746 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2118 N TYLER RD, STE 101C WICHITA, KS 67212 | $0 |
| MEDTRAK SERVICES EIN 36-4221427 PPO NETWORK PROVIDER | Insurance services Service code 23 | 10895 LOWELL AVE OVERLAND PARK, KS 66210 | $0 |
| MEDWATCH, LLC EIN 16-1662117 PPO NETWORK PROVIDER | Insurance services Service code 23 | P.O. BOX 952679 LAKE MARY, FL 327952679 | $0 |
| PETRICH BENEFIT SERVICES INC EIN 27-1197779 BROKER | Insurance agents and brokers Service code 22 | 345 N RIVERVIEW STE 600 WICHITA, KS 67203 | $0 |
| WPPA INC DBA PROVIDERS CARE NETWORK EIN 48-0959093 PPO PROVIDER NETWORK | Insurance services Service code 23 | 1102 S. HILLSIDE WICHITA, KS 67211 | $0 |
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 | 207 | 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) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KANSAS, INC. | 160 | $133K |
| Vision | SURENCY LIFE AND HEALTH | 69 | $14K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 317 | $86K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 56 | $38K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 56 | $38K |
| Stop-loss / reinsurancereinsurance | NATIONAL HEALTH INSURANCE COMPANY | 205 | $253K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 317 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.