| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 Filed as: CYPRESS BENEFIT ADMINISTRATORS LLC | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | MONTGOMERY MANAGEMENT | — | $42K | $42K | 15.61% |
| MARK GALL HLU CONSULTANTS3 | 2144 GILBERT AVE CINCINNATI, OH 45206 | MONTGOMERY MANAGEMENT | — | $35K | $35K | 12.92% |
| HSTECHNOLOGY SOLUTIONS, INC3 Filed as: HSTECHNOLOGY SOLUTIONS INC | 3857 BIRCH ST. STE 586 NEWPORT BEACH, CA 92660 | MONTGOMERY MANAGEMENT | — | $12K | $12K | 4.47% |
| PREMIERE HEALTHCARE EXCHANGE3 | 2 CROSSROADS DR BEDMINSTER, NJ 07921 | MONTGOMERY MANAGEMENT | — | $6K | $6K | 2.27% |
| AMERICAN HEALTH HOLDING3 | P.O. BOX 6016 WORTHINGTON, OH 43085 | MONTGOMERY MANAGEMENT | — | $4K | $4K | 1.30% |
| MEDWATCH LLC3 | P.O. BOX 21796 TAMPA, FL 33630 | MONTGOMERY MANAGEMENT | — | $4K | $4K | 1.29% |
| HEALTH EOS3 | P.O. BOX 29380 NEW YORK, NY 100879380 | MONTGOMERY MANAGEMENT | — | $3K | $3K | 1.28% |
| AKESO CARE MANAGEMENT3 | 2960 NORTH MERIDAN ST INDIANAPOLIS, IN 46208 | MONTGOMERY MANAGEMENT | — | $962 | $962 | 0.36% |
| SAGAMORE HEALTH NETWORK3 Filed as: SAGAMORE HEALTHCARE | 11595 N MERIDAN ST. STE 600 CARMEL, IN 460326910 | MONTGOMERY MANAGEMENT | — | $37 | $37 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AKESO CARE MANAGEMENT EIN 39-1980029 | Other fees Service code 99 | 2960 NORTH MERIDAN ST INDIANAPOLIS, IN 46208 | $0 |
| AMERICAN HEALTH HOLDING EIN 31-1368946 | Other fees Service code 99 | P.O. BOX 6016 WORTHINGTON, OH 43085 | $0 |
| CYPRESS BENEFIT ADMINISTRATORS EIN 39-1997579 | Claims processing Service code 12 | 5560 W. GRANDE MARKET DR APPLETON, WI 54913 | $0 |
| HEALTH EOS EIN 39-1634080 | Other fees Service code 99 | P.O. BOX 29380 NEW YORK, NY 100879380 | $0 |
| HSTECHNOLOGY SOLUTIONS INC EIN 27-1818792 | Other fees Service code 99 | 3857 BIRCH ST. STE 586 NEWPORT BEACH, CA 92660 | $0 |
| MARK GALL HLU CONSULTANTS EIN 31-0622691 | Custodial (securities) Service code 19 | 2144 GILBERT AVE CINCINNATI, OH 45206 | $0 |
| MEDWATCH LLC EIN 16-1662117 | Other fees Service code 99 | P.O. BOX 21796 TAMPA, FL 33630 | $0 |
| PREMIERE HEALTHCARE EXCHANGE EIN 86-1040704 | Other fees Service code 99 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | $0 |
| SAGAMORE HEALTH CARE EIN 35-1641636 | Other fees Service code 99 | 11595 N. MERIDAN ST. STE CARMEL, IN 460326910 | $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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MONTGOMERY MANAGEMENT | 125 | $271K |
| Dental | MONTGOMERY MANAGEMENT | 125 | $271K |
| Prescription drug | MONTGOMERY MANAGEMENT | 125 | $271K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.