| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MEDICAL BENEFITS ADMINISTRATORS5 | 1975 TAMARACK RD NEWARK, OH 43055 | BERKLEY | $2K | — | $2K | 1.93% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 400 GALLERIA PARKWAY SUITE 300 ATLANTA, GA 30339 | HCCB | $6K | — | $6K | 11.00% |
| MEDICAL BENEFITS ADMINISTRATORS5 | 1975 TAMARACK RD NEWARK, OH 43055 | HCCB | $2K | — | $2K | 3.08% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INS INC | 10800 BISCAYNE BLVD STE 850 MIAMI, FL 331617428 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INS INC | 10800 BISCAYNE BLVD STE 850 MIAMI, FL 331617428 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICAL BENEFITS ADMINISTRATORS EIN 31-1249371 CONTRACT | Plan Administrator Service code 14 | — | $30K |
| MEDICAL BENEFITS MUTUAL EIN 31-4210910 CONTRACT | Other fees Service code 99 | — | $8K |
| 4MOST EIN 31-1538612 CONTRACT | Other fees Service code 99 | — | $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 | 93 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 93 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | METROPOLITAN LIFE INSURANCE COMPANY | 93 | $0 |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKLEY | 93 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 93 | — |
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.