| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KLEIN FINANCIAL BENEFITS INC3 | BLDG ONE #200 JACKSONVILLE, FL 32256 | AMERICAN FIDELITY ASSURANCE COMPANY | $10K | — | $10K | 4.88% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $6K | — | $6K | 2.86% |
| AUTOMOBILE DEALERS ASSOC OF ALABAMA3 | P.O. BOX 231058 MONTGOMERY, AL 36106 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $2K | $2K | 0.98% |
| KLEIN FINANCIAL BENEFITS INC3 | BLDG ONE #200 JACKSONVILLE, FL 32256 | AMERICAN FIDELITY ASSURANCE COMPANY | $5K | — | $5K | 5.00% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | — | $2K | 1.58% |
| AUTOMOBILE DEALERS ASSOC OF ALABAMA3 | P.O. BOX 231058 MONTGOMERY, AL 36106 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $1K | $1K | 1.06% |
| AMERICAN FIDELITY GENERAL AGENCY3 | 9000 CAMERON PARKWAY OKLAHOMA CITY, OK 73114 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $4K | — | $4K | 19.54% |
| AMERICAN FIDELITY GENERAL AGENCY3 Filed as: AMERICAN FIDELITY GEN AGCY | 9000 CAMERON PARKWAY OKLAHOMA CITY, OK 73114 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| AMERICAN FIDELITY GENERAL AGENCY3 | 9000 CAMERON PARKWAY OKLAHOMA CITY, OK 73114 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALTERNATIVE INSURANCE RESOURCES, IN EIN 72-1382665 TPA ADMINISTRTOR | Plan Administrator Service code 14 | — | $19K |
| THE VALENT GROUP EIN 63-1284353 BROKER | Insurance agents and brokers Service code 22 | — | $18K |
| STANDARD LIFE & ACCIDENT INSURANCE EIN 72-0994234 STOP LOSS CARRIER | Insurance services Service code 23 | — | $8K |
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 | 180 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS & BLUE SHIELD OF ALABAMA | 258 | $1.4M |
| Dental | BLUE CROSS & BLUE SHIELD OF ALABAMA | 258 | $1.2M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 259 | $18K |
| Life insurance(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 189 | $26K |
| Short-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 91 | $297K |
| Long-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 91 | $297K |
| Prescription drug | BLUE CROSS & BLUE SHIELD OF ALABAMA | 258 | $1.2M |
| Other(5 contracts, 3 carriers) | BLUE CROSS & BLUE SHIELD OF ALABAMA | 258 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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."
No prospect flags tripped on this filing.