| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOUNDATION RISK PARTNERS CORP3 | 9700 ORMSBY STATION RD LOUISVILLE, KY 40223 | DELTA DENTAL OF KENTUCKY | $1K | — | $1K | 0.55% |
| FIFTH THIRD INSURANCE AGENCY INC3 | 8335 KEYSTONE XING STE 106 INDIANAPOLIS, IN 46240 | DELTA DENTAL OF KENTUCKY | $612 | — | $612 | 0.29% |
| FOUNDATION RISK PARTNERS CORP3 | 9700 ORMSBY STATION RD #200 LOUISVILLE, KY 40223 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 13.83% |
| FIFTH THIRD INSURANCE AGENCY INC3 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45202 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $967 | — | $967 | 1.17% |
| FOUNDATION RISK PARTNERS CORP3 | 9700 ORMSBY STATION RD #200 LOUISVILLE, KY 40223 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 13.91% |
| FIFTH THIRD INSURANCE AGENCY INC3 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45202 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $547 | — | $547 | 1.09% |
| FOUNDATION RISK PARTNERS CORP3 | 9700 ORMSBY STATION RD #200 LOUISVILLE, KY 40223 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 13.93% |
| FIFTH THIRD INSURANCE AGENCY INC3 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45202 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $453 | — | $453 | 1.07% |
| MCCONNELL INSURANCE AGENCY SERVICES3 | ATTN JOHN MCCONNELL MURRAY, KY 42071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.75% |
| EMPLOYEE BENEFIT SOLUTIONS INC3 Filed as: EMPLOYEE BENEFIT SOLUTIONS LLC | 2785 MAYFIELD HIGHWAY BENTON, KY 42025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $665 | $12 | $677 | 1.67% |
| KING INSURANCE AGENCY3 Filed as: KING INSURANCE SERVICES INC | 703 JEFFERSON STREET PADUCAH, KY 42001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $435 | — | $435 | 1.07% |
| ANDREW THOMAS DONOHOO3 | 2250 HAL DR MURRAY, KY 42071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $359 | $4 | $363 | 0.90% |
| ANGELA K ROWLETT LAMPE3 | 4384 VAN CLEAVE ROAD MURRAY, KY 42071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $205 | — | $205 | 0.51% |
| TED BENNETT3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $126 | — | $126 | 0.31% |
| HOLLANDSTIVERS EMPLOYER SOLUTIONS L3 | 2660 OLIVET CHURCH RD PADUCAH, KY 42001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 0.28% |
| DEBORAH S GOLDEN3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | — | $92 | 0.23% |
| FRANKIE GLEE WILLIAMS3 | 206 HURRICANE SHORES RD SCOTTSVILLE, KY 42164 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.08% |
| SUSAN MAE DANIEL3 | 2713 CAYCE MEADE DRIVE HOPKINSVILLE, KY 42240 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.07% |
| FIFTH THIRD INSURANCE AGENCY INC3 | — | TELEDOC | $4K | — | $4K | 15.00% |
| FOUNDATION RISK PARTNERS CORP3 | — | MEDICAL AIR SERVICES ASSOCIATION, INC. | $2K | — | $2K | 10.00% |
| KAREIM R CADE3 | 29177 WELLINGTON CT SOUTHFIELD, MI 48034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.61% |
| TONI JACKSON3 | 17341 BIRCHCREST DETROIT, MI 48221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.49% |
| CONSOIDATED FINANCIAL CORPORATION3 | 28411 NORTHWESTERN HWY SOUTHFIELD, MI 48034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.12% |
| GREAT LAKES BENEFIT GROUP3 Filed as: GREAT LAKES BENEFIT GROUP LLC | 512 NORTH MAIN STREET ROYAL OAK, MI 48067 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.12% |
| KENNETH JAMES BOWERY3 | 3090 MAIN STREET #2 MARLETTE, MI 48453 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF KENTUCKY INC EIN 61-1237516 ADMIN/NETWORK PHARMACY | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Other fees; Contract Administrator Service code 12 | — | $548K |
| FIFTH THIRD INSURANCE AGENCY INC | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $55K |
| FOUNDATION RISK PARTNERS CORP | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $27K |
| INGENIORX, INC. EIN 82-3062245 ADMIN | Float revenue; Other services; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | -$137K |
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 | 634 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 634 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KENTUCKY | 1,124 | $212K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 634 | $83K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 64 | $40K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 281 | $50K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 1,020 | $673K |
| Other(6 contracts, 5 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 634 | $237K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,124 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.