| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTHSMART BENEFIT SOLUTIONS5 | P O BOX 167429 IRVING, TX 75016 | HCC LIFE INSURANCE COMPANY | $9K | — | $9K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSMART EIN 75-2960859 NONE | Other fees; Claims processing Service code 12 | — | $229K |
| BLUE CROSS BLUE SHIELD OF GA INC. EIN 58-1638390 VENDOR | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $122K |
| DELTA DENTAL OF OHIO EIN 31-0685339 VENDOR | Claims processing Service code 12 | — | $61K |
| COMPSYCH EIN 36-3739783 VENDOR | Claims processing Service code 12 | — | $33K |
| HEALTHCARE STRATEGIES EIN 52-1874471 NONE | Other fees Service code 99 | — | $20K |
| TELADOC EIN 04-3705970 VENDOR | Claims processing Service code 12 | — | $16K |
| CVS CAREMARK EIN 95-3382344 VENDOR | Claims processing Service code 12 | — | $16K |
| BLUE CROSS BLUE SHIELD OF GA INC | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $12K |
| SPECTERA, INC EIN 52-1260282 VENDOR | Contract Administrator Service code 13 | — | $12K |
| EMPLOYERS HEALTH PURCHASING GROUP EIN 34-1893487 BROKER | Other commissions Service code 55 | — | $2K |
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 | 1,341 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,341 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 1,341 | $474K |
| Prescription drug | HCC LIFE INSURANCE COMPANY | 1,341 | $474K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,341 | — |
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.