| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC3 Filed as: ACS BENEFIT SERVICES, LLC | 470 W. HANES MILL ROAD SUITE 100 WINSTON-SALEM, NC 27105 | ROCKPORT BENEFITS (A DIVISION OF IOA RE, LLC) | $13K | — | $13K | 7.62% |
| BAIN JR, EUGENE3 Filed as: BAIN, EARL E JR. | PO BOX 53574 FAYETTEVILLE, NC 28305 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 15.02% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $195 | $1K | 5.97% |
| ACS BENEFIT SERVICES LLC3 Filed as: ACS BENEFIT SERVICES, LLC | 470 W. HANES MILL ROAD SUITE 100 WINSTON-SALEM, NC 27105 | CIGNA | — | — | $0 | 0.00% |
| BAIN JR, EUGENE3 Filed as: BAIN, EARL E JR. | PO BOX 53574 FAYETTEVILLE, NC 28305 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $269 | — | $269 | 14.98% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $90 | $20 | $110 | 6.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACS BENEFIT SERVICES, LLC EIN 56-1472467 SERVICE PROVIDER | Contract Administrator; Claims processing Service code 12 | — | $46K |
| EARL EUGENE BAIN, JR. EIN 24-4985935 SERVICE PROVIDER | Insurance brokerage commissions and fees Service code 53 | — | $33K |
| VOLTAIRE HEALTH, DBA PAYER COMPASS EIN 46-2047081 SERVICE PROVIDER | Other services Service code 49 | — | $12K |
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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA | 93 | $5K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 123 | $20K |
| Stop-loss / reinsurancereinsurance | ROCKPORT BENEFITS (A DIVISION OF IOA RE, LLC) | 93 | $173K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 123 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.