| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MATTHEW SULLIVAN, LION STREET FINAN3 | 3320 WESTRAC DR STE D FARGO, ND 58103 | GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY | $880 | $0 | $880 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LION STREET FINANCIAL LLC BROKER / ADVISOR | Other commissions Service code 55 | 515 CONGRESS AVE STE 2500 AUSTIN, TX 78701 | $12K |
| GOLDLEAF PARTNERS EIN 45-0514557 CONTRACT ADMIN | Contract Administrator Service code 13 | P.O. BOX 806 BRAINERD, MN 56401 | $10K |
| WIDMER ROEL PC EIN 45-0334950 AUDITOR | Accounting (including auditing) Service code 10 | 4334 18TH AVE S STE 101 FARGO, ND 58103 | $10K |
| EMPOWER RETIREMENT ADVISORY SERVICE INVESTMENT MANAGEMENT | Investment management Service code 28 | 8515 EAST ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 | $2K |
| GREAT-WEST LIFE & ANNUITY INSURANCE EIN 84-0467907 RECORDKEEPER | Recordkeeping fees Service code 64 | 8515 EAST ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 | $1K |
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. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 50 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY | 8 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.