| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE BUCKNER COMPANY3 Filed as: THE BUCKNER GROUP | 6550 S MILLROCK DR SALT LAKE CITY, UT 84121 | LIFE INSURACE COMPANY OF NORTH AMERICA | $1K | — | $1K | 4.37% |
| GBS BENEFITS INC3 | 465 S 400 E SALT LAKE CITY, UT 84111 | LIFE INSURACE COMPANY OF NORTH AMERICA | $232 | — | $232 | 0.71% |
| THE BUCKNER COMPANY3 Filed as: THE BUCKNER GROUP | 6550 S MILLROCK DR SALT LAKE CITY, UT 84121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $344 | — | $344 | 4.61% |
| GBS BENEFITS INC3 | 465 S 400 E SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $57 | — | $57 | 0.76% |
| THE BUCKNER COMPANY3 Filed as: THE BUCKNER GROUP | 6550 S MILLROCK DR SALT LAKE CITY, UT 84121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $738 | — | $738 | 12.82% |
| THE BUCKNER COMPANY3 Filed as: THE BUCKNER GROUP | 6550 S MILLROCK DR SALT LAKE CITY, UT 84121 | LIFE INSURANCE COMPNAY OF NORTH AMERICA | $78 | — | $78 | 5.10% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS, INC | 465 S 400 E SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPNAY OF NORTH AMERICA | $11 | — | $11 | 0.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS PROCESSING | Contract Administrator; Named fiduciary; Direct payment from the plan; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $4K |
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 | 105 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA | 72 | $119K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $7K |
| Other | LIFE INSURANCE COMPNAY OF NORTH AMERICA | 0 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 72 | — |
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.