| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 Filed as: EBENCONCEPTS | 639 EXECUTIVE PLACE SUITE 202 FAYETTEVILLE, NC 28305 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 15.00% |
| ERIK G LILJENWALL3 Filed as: ERIK LILJENWALL | 4130 SPICEWOOD SPRINGS RD SUITE 200 AUSTIN, TX 78759 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $34 | — | $34 | 0.05% |
| OPES ONE ADVISORS LLC3 | 15303 DALLAS PARKWAY ADDISON, TX 75001 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $29 | — | $29 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYERS DIRECT HEALTH EIN 75-2322062 TPA | Contract Administrator; Claims processing Service code 12 | — | $16K |
| EBENCONCEPTS COMPANY INC EIN 75-2966596 CONSULTANT | Consulting (general); Consulting fees Service code 16 | — | $10K |
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 | 131 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 91 | $163K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $73K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $73K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $73K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 91 | $163K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 91 | $163K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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.