| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JILL HARROD, INC.3 | 2300 MEADOW DRIVE, STE 203 LOUISVILLE, KY 40218 | HARTFORD LIFE AND ACCIDENT | $63K | — | $63K | 5.00% |
| JILL HARROD, INC.3 | 2300 MEADOW DRIVE, STE 203 LOUISVILLE, KY 40218 | HARTFORD LIFE AND ACCIDENT | $655 | — | $655 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS & BLUE SHIELD EIN 61-1237516 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $658K |
| THE SEGEL COMPANY EIN 13-1975125 NONE | Consulting (general) Service code 16 | — | $98K |
| DEBORAH REID EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $78K |
| STAR RAINES EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $75K |
| ISSI EIN 23-2182079 NONE | Other services Service code 49 | — | $60K |
| MEDICAL COST MANAGEMENT EIN 36-3445315 NONE | Consulting (general) Service code 16 | — | $58K |
| LISA AMSHOFF EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $55K |
| JENNIFER BURGIN EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| WAYNE CORPORATION EIN 61-1129889 NONE | Other services Service code 49 | — | $50K |
| DUNN AND WALLBAUM, PLLC EIN 46-1576504 NONE | Legal Service code 29 | — | $48K |
| LISA CARROLL EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $44K |
| MCM CPAS & ADVISORS LLP EIN 27-1235638 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $39K |
| STEPHANIE HOPKINS EIN 61-0605310 EMPLOYEE | Employee (plan) Service code 30 | — | $30K |
| ADVANCED BUSINESS SOLUTIONS EIN 61-1297426 NONE | Consulting (general) Service code 16 | — | $26K |
| CS MCKEE EIN 25-1900687 NONE | Investment management Service code 28 | — | $20K |
| STANDARD VALUATIONS INC. EIN 41-1327339 NONE | Investment advisory (plan) Service code 27 | — | $20K |
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 | 1,715 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 447 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | HARTFORD LIFE AND ACCIDENT | 536 | $1.3M |
| Other(2 contracts) | HARTFORD LIFE AND ACCIDENT | 536 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 536 | — |
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.