| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RISK & INSURANCE CONSULTING SERVICE3 | 5500 LILBURN STONE MOUNTAIN RD SUITE B STONE MOUNTAIN, GA 30087 | HCC LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEMPTON GROUP ADMINISTRATORS, INC. EIN 73-1201547 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 515 CENTRAL PARK DRIVE SUITE 106 OKLAHOMA CITY, OK 73105 | $56K |
| STRATEGIC EMPLOYEE BENEFITS EIN 73-1608924 AGENT | Custodial (securities) Service code 19 | 7030 S YALE TULSA, OK 74136 | $31K |
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 | 131 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 131 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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.