| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTHCARE SOLUTIONS GROUP, INC.3 | P.O. BOX 1309 MUSKOGEE, OK 74402 | COMPANION LIFE | $5K | — | $5K | 3.09% |
| 90 DEGREE BENEFITS COMPANY | PO BOX 1309 MUSKOGEE, OK 74402 | DELTA DENTAL | $4K | — | $4K | 6.00% |
| HEALTHCARE SOLUTIONS GROUP, INC.3 | P.O. BOX 1309 MUSKOGEE, OK 74402 | OPTUMHEALTH CARE SOLUTIONS | $545 | — | $545 | 5.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCARE SOLUTIONS GROUP INC EIN 73-1478844 PLAN SUPERVISOR | Contract Administrator Service code 13 | PO BOX 1309 MUSKOGEE, OK 74402 | $86K |
| MULTIPLAN, INC EIN 13-3068979 PPO NETWORK | Contract Administrator Service code 13 | — | $11K |
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 | 154 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE | 152 | $159K |
| Dental | DELTA DENTAL | 154 | $65K |
| Other | OPTUMHEALTH CARE SOLUTIONS | 152 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 154 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.