| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NL, LLC | 2305 RIVER ROAD LOUISVILLE, KY 40206 | DELTA DENTAL OF KENTUCKY | $17K | — | $17K | 3.53% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INS AGENCY INC | 5905 E GALBRAITH RD. - STE 5000 CINCINNATI, OH 452362378 | MATRIX GROUP - NATIONWIDE | $38K | — | $38K | 9.01% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NL, LLC | 2305 RIVER ROAD LOUISVILLE, KY 40206 | RELIASTAR LIFE INSURANCE COMPANY | $26K | — | $26K | 31.54% |
| AP BENEFIT ADVISORS, LLC3 | 200 INTERNATIONAL CIR STE 4500 COCKEYSVILLE, MD 21030 | RELIASTAR LIFE INSURANCE COMPANY | $2K | — | $2K | 2.10% |
| T2B SOLUTIONS INC.3 Filed as: T2B SOLUTIONS INC | PO BOX 43 INDIANOLA, IA 50125 | RELIASTAR LIFE INSURANCE COMPANY | — | $210 | $210 | 0.25% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY | 5905 E GALBRAITH RD. - STE 5000 CINCINNATI, OH 452362378 | THE DENTAL CONCERN, INC. - HUMANA | $3K | — | $3K | 5.07% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NL, LLC | 2305 RIVER RD LOUISVILLE, KY 40206 | DELTA DENTAL OF KENTUCKY | — | — | $0 | 0.00% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY | 4500 TOWN CENTER BLVD - SUITE 200 JEFFERSONVILLE, IN 47130 | PAN-AMERICAN LIFE INSURANCE COMPANY | $9K | $90K | $99K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXPRESS SCRIPTS, INC. EIN 43-1420563 PHARMACY BENEFIT MGT | Other fees; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $2.1M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $575K |
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 | 1,054 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 53 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PAN-AMERICAN LIFE INSURANCE COMPANY | 96 | $0 |
| Dental(2 contracts) | DELTA DENTAL OF KENTUCKY | 1,460 | $474K |
| Vision | THE DENTAL CONCERN, INC. - HUMANA | 699 | $55K |
| Stop-loss / reinsurancereinsurance | MATRIX GROUP - NATIONWIDE | 732 | $417K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 380 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,460 | — |
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.