| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHILD HEALTH CORP OF AMERICA3 | 16011 COLLEGE BLVD SUITE 250 LENEXA, KS 66219 | HARTFORD LIFE AND ACCIDENT | $177K | $51K | $227K | 9.00% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT | — | $82K | $82K | 3.26% |
| CHILD HEALTH CORP OF AMERICA3 Filed as: CHILD HEALTH CORP. OF AMERICA | 16011 COLLEGE BLVD. SUITE 250 LENEXA, KS 66219 | HARTFORD LIFE AND ACCIDENT | $7K | $3K | $10K | 7.09% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 2.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET NEW YORK, NY 102810000 | FEDERAL INSURANCE COMPANY | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE, INC. EIN 35-1846036 NONE | Plan Administrator; Other services; Claims processing Service code 12 | — | $1.5M |
| CIGNA PPO EIN 59-1031071 NONE | Other services; Claims processing Service code 12 | — | $651K |
| DELTA DENTAL OF TENNESSEE EIN 62-0812197 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $158K |
| MULTIPLAN, INC. EIN 13-3068979 NONE | Claims processing; Plan Administrator; Other services Service code 12 | — | $95K |
| ALERE EIN 58-2318139 NONE | Claims processing; Other services Service code 12 | — | $7K |
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 | 4,619 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,642 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | ADVANTICA REINSURANCE COMPANY | 8,746 | $528K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 9,226 | $2.5M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 9,226 | $2.5M |
| Other(3 contracts, 3 carriers) | METROPOLITAN PROPERTY & CASUALTY INSURANCE CO | 4,495 | $338K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,226 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.