| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 2975 REGENT BLVD. IRVING, TX 75063 | DELTA DENTAL OF KENTUCKY | $389 | — | $389 | 0.64% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 720 E PETE ROSE WAY #400 CINCINNATI, OH 45202 | EYEMED VISION CARE | $474 | — | $474 | 3.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 720 E PETE ROSE WAY #400 CINCINNATI, OH 45202 | EYEMED VISION CARE | $112 | — | $112 | 0.78% |
| VICKIE R. WILLIAMS3 Filed as: VICKIE R WILLIAMS | 2910 KLONDIKE LN LOUISVILLE, KY 40218 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $291 | — | $291 | 2.58% |
| VANCE NEAL MICHAEL3 | 1005 RICHMOND RD LEXINGTON, KY 40502 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | $35 | $130 | 1.15% |
| THE JAMES B OSWALD COMPANY3 Filed as: JAMES M BENNETT | PO BOX 573 FRANKFORT, KY 40602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | — | $34 | 0.30% |
| RALPH E MYERS3 | 13117 EASTPOINT PARK BLVD LOUISVILLE, KY 40223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.26% |
| MICHAEL J BOONE3 | 1302 CLEAR SPRINGS TRACE LOUISVILLE, KY 40223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.19% |
| TED BENNETT3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.16% |
| BRIAN K TAYLOR3 | 1400 NORTHWIND RD LOUISVILLE, KY 40207 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.14% |
| MARY DUFF3 | 1005 RICHMOND RD LEXINGTON, KY 40502 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $2 | $14 | 0.12% |
| DEBORAH S GOLDEN3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.12% |
| VICKIE E LEWIS3 | 6558 STOVALL RD CAVE CITY, KY 42127 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.09% |
| MARK CHRISTOPHER HOLLAND3 | PO BOX 38366 GERMANTOWN, TN 38183 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| COURTLANN M ATKINSON3 | 618 FAIRWAY ST BOWLING GREEN, KY 42103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARM. BENEFIT MANAGEMENT | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $340K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $45K |
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 | 143 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KENTUCKY | 287 | $61K |
| Vision | EYEMED VISION CARE | 236 | $14K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 70 | $17K |
| Other(2 contracts, 2 carriers) | QBE INSURANCE CORPORATION | 127 | $243K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.