| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHELDON D. BARRON3 | PO BOX 699 JAMESTOWN, TN 385560699 | UNITED HEALTHCARE INSURANCE COMPANY | $19K | — | $19K | 4.15% |
| MATHER & STROHL ADMIN SVCS INC3 | 12404 PARK CENTRAL, SUITE 400S DALLAS, TX 75251 | HARTFORD LIFE AND ACCIDENT | $650 | $93 | $743 | 23.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CHARTER BENEFITS GROUP EIN 34-2007401 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $15K |
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 | 48 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 48 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 48 | $451K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 48 | $451K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 48 | $451K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 26 | $3K |
| Other | HARTFORD LIFE AND ACCIDENT | 26 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 48 | — |
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.