| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | P.O BOX 203417 DALLAS, TX 75320 | DELTA DENTAL OF KENTUCKY | $3K | — | $3K | 5.05% |
| VICKI R. WILLIAMS3 | 111 N. EWING AVE. LOUISVILLE, KY 40206 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $710 | — | $710 | 2.68% |
| TED BENNETT3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $18 | $119 | 0.45% |
| MICHAEL E. RIDER3 | 303 CLEVELAND AVENUE GLASGOW, KY 42141 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | — | $75 | 0.28% |
| MARYANNE ANDERSON3 | 1014 EDGEFIELD WAY BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $73 | $1 | $74 | 0.28% |
| RALPH E MYERS3 Filed as: RALPH E. MYERS | 13117 EASTPOINT PARK BLVD. LOUISVILLE, KY 40223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | — | $72 | 0.27% |
| DEBORAH S GOLDEN3 Filed as: DEBORAH S. GOLDEN | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | $5 | $72 | 0.27% |
| THE JAMES B OSWALD COMPANY3 Filed as: JAMES M. BENNETT | P.O BOX 573 FRANKFORT, KY 40602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | — | $40 | 0.15% |
| BRIAN K TAYLOR3 Filed as: BRIAN K. TAYLOR | 7410 NEW LAGRANGE ROAD LOUISVILLE, KY 40222 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.14% |
| MICHAEL J BOONE3 Filed as: MICHAEL J. BOONE | 1302 CLEAR SPRINGS TRACE LOUISVILLE, KY 40223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.10% |
| VICKIE E LEWIS3 Filed as: VICKIE E. LEWIS | 6558 STOVALL RD. CAVE CITY, KY 42127 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.06% |
| COURTLANN M ATKINSON3 Filed as: COURTLANN M. ATKINSON | 618 FAIRWAY ST. BOWLING GREEN, KY 42103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.03% |
| MARK HOLLAND3 | P.O BOX 38366 GERMANTOWN, TN 38183 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| SUZANNE S HENDERSON-CIOTTI3 Filed as: SUZANNE S. HENDERSON-CIOTTI | 2619 HEDGEPATH TRAIL LOUISVILLE, KY 40245 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.02% |
| RICHARD RAMEY3 Filed as: RICHARD THARRINGTON | 1053 BULLARD COURT RALEIGH, NC 27615 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | 720E PETE ROSE WAY #400 CINCINNATI, OH 45202 | THE LINCOLN NATIONAL INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 1014 VINE ST. SUITE 1100 CINCINNATI, OH 45202 | EYEMED VISION CARE | $1K | — | $1K | 9.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXPRESS SCRIPTS, INC. | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing; Float revenue Service code 12 | — | $63K |
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 | 132 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 122 | $213K |
| Dental | DELTA DENTAL OF KENTUCKY | 122 | $51K |
| Vision | EYEMED VISION CARE | 87 | $16K |
| Life insurance | THE LINCOLN NATIONAL INSURANCE COMPANY | 0 | $16K |
| Prescription drug | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 122 | $213K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 42 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 122 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.