| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURED NEACE LUKENS INS. AGENCY3 Filed as: ASSURED NEACE LUKENS INSURANCE AGEN | 3000 MERIDIAN BOULEVARD SUITE 100 FRANKLIN, TN 37067 | UNITED HEALTHCARE INSURANCE COMPANY | $61K | — | $61K | 4.00% |
| ASSURED NEACE LUKENS INS. AGENCY3 Filed as: ASSURED NEACE LUKENS INSURANCE AGEN | 2305 RIVER ROAD LOUISVILLE, KY 40206 | DELTA DENTAL OF KENTUCKY | $3K | — | $3K | 3.89% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 4000 SMITH ROAD SUITE 400 CINCINNATI, OH 45209 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 18.87% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 6510 NORTH SHADELAND AVENUE INDIANAPOLIS, IN 46220 | NATIONAL GUARDIAN LIFE | $2K | — | $2K | 9.15% |
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 | 172 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 164 | $1.5M |
| Dental | DELTA DENTAL OF KENTUCKY | 385 | $86K |
| Vision | NATIONAL GUARDIAN LIFE | 151 | $24K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $56K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $56K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 164 | $1.5M |
| Other(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 200 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.