| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERITAIN HEALTH3 | 10150 SOUTH CENTENNIAL PARKWAY SUITE 450 SANDY, UT 84070 | HCC LIFE INSURANCE COMPANY | -$921 | — | -$921 | -0.40% |
| ROGER HICKS & ASSOCIATES3 | GROUP INSURANCE AGENCY P O BOX 18169 OKLAHOMA CITY, OK 731540169 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 7.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $44 | $44 | 0.05% |
| ROGER HICKS & ASSOCIATES3 | GROUP INSURANCE AGCY PO BOX 18169 OKLAHOMA CITY, OK 731540169 | DELTA DENTAL | $5K | $6K | $10K | 12.72% |
No Schedule C service providers reported on this filing.
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 135 | $228K |
| Dental | DELTA DENTAL | 126 | $82K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 132 | $85K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 132 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.