| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RISK & INSURANCE CONSULTING SERVICE3 Filed as: RISK & INSURANCE CONSULTING SRVCS | 5500 LILBURN STONE MOUNTAIN ROAD SU STONE MOUNTAIN, GA 30087 | AMERICAN NATIONAL INSURANCE COMPANY | $7K | $0 | $7K | 1.00% |
| TRILOGY PURCHASING ALLIANCE LLC3 Filed as: TRILOGY PURCHASING ALLIANCE, LLC | 1601 S STATE ST STE 600 EDMOND, OK 73013 | DELTA DENTAL | $2K | $25K | $27K | 8.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEMPTON GROUP ADMINISTRATORS EIN 73-1201547 NONE | Contract Administrator Service code 13 | P.O. BOX 54889 OKLAHOMA CITY, OK 731541889 | $199K |
| MAXCARE, INC. EIN 73-1250178 NONE | Claims processing Service code 12 | PO BOX 18204 OKLAHOMA CITY, OK 73154 | $38K |
| FIRST HEALTH GROUP, CORP EIN 20-1736437 NONE | Claims processing Service code 12 | 9229 WARD PARKWAY, SUITE 300 KANSAS CITY, MO 64114 | $28K |
| DELTA DENTAL EIN 23-7322578 NONE | Claims processing Service code 12 | — | $25K |
| MEDCOM CARE MANAGEMENT, INC. EIN 72-1339762 NONE | Claims processing Service code 12 | — | $14K |
| SOMERSET CPAS, P.C. EIN 20-1717681 NONE | Accounting (including auditing) Service code 10 | 3925 RIVER CROSSING PARKWAY INDIANAPOLIS, IN 46240 | $13K |
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 | 584 | 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) | 584 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 551 | $311K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL INSURANCE COMPANY | 584 | $692K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 584 | — |
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.