| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JARRELL BLACK AND COMPANY, LLC3 Filed as: JARRELL BLACK AND CO, LLC | 65 CHASE DR STE 2 HURRICANE, WV 25526 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $1K | $5K | 14.00% |
| JARRELL BLACK AND COMPANY, LLC Filed as: JARRELL BLACK & COMPANY | 65 CHASE DRIVE STE 2 HURRICANE, WV 25526 | RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 10.00% |
| JARRELL BLACK AND COMPANY, LLC | 45 CHASE DRIVE SUITE 2 HURRICANE, WV 25526 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 13.00% |
| JARRELL BLACK AND COMPANY, LLC3 Filed as: THE JARRELL GROUP | 87 CHASE DRIVE HURRICANE, WV 25526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $317 | — | $317 | 4.19% |
| LINDA S SHINN3 | 317 CHURCH ST PADEN CITY, WV 26159 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $268 | $36 | $304 | 4.01% |
| MOUNTAIN STATE EMPLOYEE BENEFITS3 Filed as: MOUNTAIN STATE EMPLOYEE BENEFITS LL | 103 6TH AVENUE ST ALBANS, WV 25177 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $231 | — | $231 | 3.05% |
| GARY LEE LACY3 | 12 MEADOW RIDGE DRIVE HURRICANE, WV 25526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | — | $67 | 0.88% |
No Schedule C service providers reported on this filing.
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 | 138 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 100 | $33K |
| Vision | RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA | 102 | $12K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 30 | $10K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 17 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.