| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES | 3810 E. SUNSHINE SUITE 200 SPRINGFIELD, MO 65809 | HCC LIFE INSURANCE COMPANY | $14K | $37K | $50K | — |
| RELIANCE STANDARD LIFE INSURANCE3 | P.O. BOX 3124 SOUTHEASTERN, PA 19398 | HCC LIFE INSURANCE COMPANY | — | $31K | $31K | — |
| TIM LEAKE3 | 3033 NW 63RD ST., STE 208 EAST OKLAHOMA CITY, OK 73116 | HCC LIFE INSURANCE COMPANY | $28K | — | $28K | — |
| MERITAIN HEALTH3 Filed as: AETNA SIGNATURE ADMINISTRATORS | 29742 NETWORK PLACE CHICAGO, IL 60673 | HCC LIFE INSURANCE COMPANY | — | $13K | $13K | — |
| PHCS3 Filed as: PHCS/MULTIPLAN | 3345 MICHELSON DRIVE, STE 200 IRVINE, CA 92612 | HCC LIFE INSURANCE COMPANY | — | $6K | $6K | — |
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 | 64 | 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) | 64 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Dental | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Vision | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Life insurance | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Long-term disability | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Prescription drug | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 64 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 64 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.