| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT MANAGEMENT, INC.3 Filed as: BENEFIT MANAGEMENT INC | PO BOX 1090 2015 - 16TH STREET GREAT BEND, KS 67530 | HIGHMARK | $938 | — | $938 | 0.17% |
| DELTA DENTAL OF KANSAS3 | 119 N WATERFRONT PARKWAY PO BOX 789769 WICHITA, KS 672789769 | DELTA DENTAL OF KANSAS | $38K | — | $38K | 8.42% |
| SARA SAMPSON3 | PO BOX 976 HUTCHINSON, KS 67504 | VCP SERVICES, INC. DBA VISION CARE DIRECT | $14K | — | $14K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT MANAGEMENT, INC. EIN 48-1168746 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $211K |
| AMERICAN HERITAGE DBA ALLSTATE BENE EIN 59-0781901 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $105K |
| WPPA DBA PROVIDRS CARE EIN 48-0959093 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $65K |
| PRE-PAID LEGAL SERVICES DBA LEGALSH EIN 73-1016728 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $23K |
| MEDTRAK SERVICES EIN 36-4221427 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $19K |
| MEDWATCH, LLC EIN 16-1662117 CONTRACT ADMINISTATOR | Contract Administrator Service code 13 | — | $13K |
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 | 884 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 888 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KANSAS | 832 | $450K |
| Vision | VCP SERVICES, INC. DBA VISION CARE DIRECT | 888 | $138K |
| Stop-loss / reinsurancereinsurance | HIGHMARK | 802 | $554K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 888 | — |
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.