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| Provider | Services | Address | Compensation |
|---|---|---|---|
| QUEST HEALTH CAPTIVE, LLC EIN 46-4927976 OTHER FEES | Other fees Service code 99 | — | $22K |
| SCOTT INSURANCE EIN 54-0372970 INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | — | $16K |
| ALLIED BENEFIT SYSTEMS, LLC EIN 36-3086057 OTHER FEES | Other fees Service code 99 | — | $10K |
| INNOVATIVE CAPTIVE STRATEGIES CONSULTING FEES | Consulting fees Service code 70 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | $6K |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 91 | $140K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 177 | $21K |
| Vision | EYEMED VISION CARE | 90 | $3K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $14K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $9K |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.