| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 658041328 | GERBER LIFE INSURANCE COMPANY | $12K | — | $12K | — |
| THE INSURANCE SHOP INC3 Filed as: THE INSURANCE SHOP, LLC | 3809 SOUTH PROVIDENCE, SUITE A COLUMBIA, MO 65201 | GERBER LIFE INSURANCE COMPANY | $9K | — | $9K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| RELIANCE STANDARD LIFE INSURANCE CO EIN 36-0883760 LIFE INSURER | Other fees Service code 99 | TWO CITY PLACE DRIVE, SUITE 170 ST. LOUIS, MO 63141 | $53K |
| GROUP BENEFIT SERVICES, INC. EIN 43-1770779 PLAN ADMINISTRATOR | Plan Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 658041328 | $39K |
| HEALTHLINK OPEN ACCESS II EIN 43-1364135 PPO NETWORK | Other fees Service code 99 | 1000 WEST NIFONG BLDG. 3, STE. 200 COLUMBIA, MO 65203 | $14K |
| PHCS / MULTIPLAN EIN 13-3068979 PPO NETWORK | Other fees Service code 99 | 3345 MICHELSON DRIVE, STE. 200 IRVINE, CA 92612 | $10K |
| MANAGED CARE CONCEPTS EIN 86-0799129 PRECERT/CASE REVIEW | Other fees Service code 99 | 416 DONNELL ORANGE, TX 77630 | $7K |
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 | 99 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Dental | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Vision | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Life insurance | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Long-term disability | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Prescription drug | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 99 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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.