| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREEN & HALLIBURTON INC3 Filed as: GREEN & HALLIBURTON, INC | 521 BARRETT AVENUE LOUISVILLE, KY 40204 | HARTFORD LIFE AND ACCIDENT | $24K | $8K | $33K | 20.14% |
| GREEN & HALLIBURTON INC3 Filed as: GREEN & HALLIBURTON, INC | 521 BARRET AVE LOUISVILLE, KY 40204 | DELTA DENTAL OF KENTUCKY | $3K | — | $3K | 3.32% |
| VARIOUS - SEE ATTACHED3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | $3K | $11K | 31.14% |
| GREEN & HALLIBURTON INC3 Filed as: GREEN & HALLIBURTON, INC | 521 BARRET AVE LOUISVILLE, KY 40204 | DELTA DENTAL OF KENTUCKY | $2K | — | $2K | 8.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF KY, INC. EIN 61-1237516 ADMINISTRATION | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other services Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $176K |
| GREEN & HALLIBURTON INC EIN 61-1246222 BROKER AGENT | Trustee (directed); Other commissions; Insurance brokerage commissions and fees Service code 25 | 521 BARRET AVE LOUISVILLE, KY 40204 | $0 |
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 | 213 | 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) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KENTUCKY | 361 | $100K |
| Vision | DELTA DENTAL OF KENTUCKY | 259 | $21K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 301 | $162K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 301 | $162K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 301 | $162K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF KY, INC. | 289 | $165K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 301 | $198K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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.