| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MEDOVA HEALTHCARE5 | 345 N. RIVERVIEW ST SUITE 600 WICHITA, KS 67203 | NATIONAL HEALTH INSURANCE COMPANY | — | $96K | $96K | 28.61% |
| NIPC3 | 8670 W. CHEYENNE AVE SUITE 120 LAS VEGAS, NE 89129 | NATIONAL HEALTH INSURANCE COMPANY | $94K | — | $94K | 28.06% |
| PHCS4 Filed as: MULTIPLAN INC - PHCS | P.O. BOX 29380 NEW YORK, NY 10087 | NATIONAL HEALTH INSURANCE COMPANY | — | $13K | $13K | 3.92% |
| MEDCOM UTILIZATION MANAGEMENT4 | 2100 COVINGTON CENTRE COVINGTON, LA 70433 | NATIONAL HEALTH INSURANCE COMPANY | — | $5K | $5K | 1.49% |
| MEDOVA HEALTHCARE5 | 345 N. RIVERVIEW ST SUITE 600 WICHITA, KS 67203 | COFINITY, INC. | $3K | — | $3K | 121.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HRO BENEFIT ADVISORS, LLC EIN 35-2587274 INSURANCE BROKER | Insurance agents and brokers; Consulting (general) Service code 16 | 17347 VILLAGE GREEN DRIVE SUITE 111 HOUSTON, TX 77040 | $26K |
| SAFFE PROPERTY & CASUALTY, L.L.C. EIN 27-0065292 INSURANCE BROKER | Insurance agents and brokers; Consulting (general) Service code 16 | 2113 GREENBRIAR DR., SUITE E SOUTHLAKE, TX 76092 | $26K |
| INFINISOURCE, INC. EIN 38-2976613 TPA | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 15 E. WASHINTON ST. P.O. BOX 889 COLDWATER, MI 490690889 | $9K |
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 | 268 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COFINITY, INC. | 186 | $3K |
| Vision | AETNA LIFE INSURANCE COMPANY | 262 | $13K |
| Life insurance | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 280 | $87K |
| Short-term disability | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 280 | $87K |
| Long-term disability | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 280 | $87K |
| Stop-loss / reinsurancereinsurance | NATIONAL HEALTH INSURANCE COMPANY | 249 | $334K |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 374 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 374 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.