| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INS AGENCY3 | 465 S 400 E SUITE 300 SALT LAKE CITY, UT 84111 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $31K | — | $31K | 20.22% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFITS/ CLINT WADSWORTH | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC | $3K | — | $3K | 7.00% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $895 | $3K | 20.46% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $635 | $3K | 19.37% |
| GBS BENEFITS INS AGENCY3 | 465 S 400 E SUITE 300 SALT LAKE CITY, UT 84111 | ASSURITY LIFE INSURANCE | $2K | — | $2K | 44.49% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $609 | $201 | $810 | 19.96% |
| GBS BENEFITS INS AGENCY3 | 465 S 400 E SUITE 300 SALT LAKE CITY, UT 84111 | ASSURITY LIFE INSURANCE | $884 | — | $884 | 39.34% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $195 | $68 | $263 | 20.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO EIN 59-1031071 SERVICE PROVIDER | Claims processing Service code 12 | — | $4K |
| AMERICAN SPECIALITY HEALTH SERVICE PROVIDER | Float revenue; Other services; Direct payment from the plan; Participant communication; Non-monetary compensation; Named fiduciary; Claims processing; Contract Administrator Service code 12 | 10221 WATERRIDGE CIRCLE SUITE 201 SAN DIEGO, CA 92121 | $0 |
| CARECORE DBA EVICORE SERVICE PROVIDER | Named fiduciary; Participant communication; Non-monetary compensation; Float revenue; Claims processing; Direct payment from the plan; Contract Administrator; Other services Service code 12 | 400 BUCKWALTER PLACE BLVD BLUFFON, SC 29910 | $0 |
| CIGNA HEALTH & LIFE INS CO | Float revenue; Claims processing; Contract Administrator; Other services; Non-monetary compensation; Participant communication; Named fiduciary; Direct payment from the plan Service code 12 | — | $0 |
| CIGNA HEALTHY REWARDS VENDORS SERVICE PROVIDER | Direct payment from the plan; Claims processing; Named fiduciary; Contract Administrator; Non-monetary compensation; Other services; Participant communication; Float revenue Service code 12 | 4000 LUXOTTICA PLACE MASON, OH 45040 | $0 |
| MEDSOLUTIONS DBA EVICORE INC SERVICE PROVIDER | Named fiduciary; Contract Administrator; Non-monetary compensation; Claims processing; Participant communication; Float revenue; Direct payment from the plan; Other services Service code 12 | 730 COOL SPRINGS BLVD #800 FRANKLIN, TN 37067 | $0 |
| U.S. BANK NATIONAL ASSOCIATION SERVICE PROVIDER | Other services; Participant communication; Contract Administrator; Claims processing; Float revenue; Named fiduciary; Non-monetary compensation; Direct payment from the plan Service code 12 | 800 NICHOLLET MALL MINNEAPOLIS, MN 55402 | $0 |
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 | 109 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 105 | $152K |
| Dental | EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC | 128 | $44K |
| Vision | EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC | 128 | $44K |
| Life insurance(4 contracts, 2 carriers) | ASSURITY LIFE INSURANCE | 109 | $12K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 60 | $15K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 174 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.