| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PFG BENEFITS, INC.3 Filed as: PFG BENEFITS | 75 SECOND AVENUE SUITE 702 NEEDHAM, MA 02494 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 4.69% |
| PFG BENEFITS, INC.3 Filed as: PFG BENEFITS | 75 SECOND AVENUE SUITE 702 NEEDHAM, MA 02494 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 15.00% |
| PFG BENEFITS, INC.3 Filed as: PFG BENEFITS | 75 SECOND AVE. SUITE 702 NEEDHAM, MA 02494 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $349 | — | $349 | 1.23% |
| PFG BENEFITS, INC.3 Filed as: PFG BENEFITS | 75 SECOND AVE SUITE 702 NEEDHAM, MA 02494 | PROVIDENT LIFE AND ACCIDENT INSRUANCE COMPANY | $2K | — | $2K | 19.01% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS | 1125 NW COUCH STREET SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSRUANCE COMPANY | $0 | $126 | $126 | 1.15% |
| PINNACLE HR SOLUTIONS3 | 75 SECOND AVE #702 NEEDHAM, MA 02494 | EYEMED | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PFG BENEFITS EIN 47-2257650 INSURANCE AGENT | Custodial (securities) Service code 19 | 75 SECOND AVE NEEDHAM, MA 02494 | $78K |
| CYPRESS BENEFIT ADMINISTRATORS LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | $37K |
| HSTECHNOLOGY EIN 27-1818792 OTHER | Other fees Service code 99 | 3857 BIRCH STREET SUITE 586 NEW PORT BEACH, CA 92660 | $16K |
| HEALTHEOS BY MULTIPLAN, INC EIN 39-1634080 OTHER | Other fees Service code 99 | PO BOX 29940 NEW YORK, NY 10087 | $7K |
| MEDWATCH EIN 16-1662117 OTHER | Other fees Service code 99 | PO BOX 21796 TAMPA, FL 33630 | $6K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED | 201 | $10K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 66 | $85K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $201K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $201K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF AMERICA | 166 | $268K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.