| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| A. G. INSURANCE AGENCIES,INC.3 Filed as: AG INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE. 350 FORT WORTH, TX 76107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $52K | $2K | $54K | 12.71% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400 S DALLAS, TX 752511800 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $18K | — | $18K | 4.16% |
| A. G. INSURANCE AGENCIES,INC.3 Filed as: AG INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE. 350 FORT WORTH, TX 76107 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 9.99% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400 DALLAS, TX 75251 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $649 | $4K | 3.66% |
| A. G. INSURANCE AGENCIES,INC.3 Filed as: A G INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE.350 FORT WORTH, TX 76107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $697 | $12K | 21.25% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400S DALLAS, TX 75251 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 5.00% |
| A. G. INSURANCE AGENCIES,INC.3 Filed as: A G INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE.350 FORT WORTH, TX 76107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $432 | $7K | 21.25% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400S DALLAS, TX 75251 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.00% |
| A. G. INSURANCE AGENCIES,INC.3 Filed as: A G INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE.350 FORT WORTH, TX 76107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $264 | $4K | 21.25% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400S DALLAS, TX 75251 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 5.00% |
| A. G. INSURANCE AGENCIES,INC.3 Filed as: AG INSURANCE AGENCIES, INC. | 6100 WESTERN PLACE STE. 350 FORT WORTH, TX 761074600 | VISION SERVICE PLAN | $989 | — | $989 | 5.93% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. STE 400 S DALLAS, TX 752511800 | VISION SERVICE PLAN | $836 | — | $836 | 5.01% |
| EMPLOYEE NAVIGATOR, LLC4 | 7979 OLD GEORGETOWN RD, STE 300 BETHESDA, MD 208142554 | VISION SERVICE PLAN | $77 | — | $77 | 0.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMPLIFON HEARING HEALTHCARE EIN 85-0437037 REWARD PROVIDERS | Contract Administrator; Named fiduciary; Participant communication; Direct payment from the plan; Other services; Float revenue; Claims processing; Non-monetary compensation Service code 12 | FIFTH STREET TOWERS 150 S.5TH ST., STE 2300 MINNEAPOLIS, MN 55402 | $0 |
| FIT FOR LIFE EIN 38-3983812 AFFILIATED COMPANIES | Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Contract Administrator; Float revenue; Participant communication Service code 12 | — | $0 |
| OMADA HEALTH, INC. EIN 45-2355015 AFFILIATED COMPANIES | Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Claims processing; Non-monetary compensation; Float revenue; Participant communication Service code 12 | 500 SANSOME ST. #200 SAN FRANCISCO, CA 94111 | $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 | 119 | 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) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $423K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 290 | $97K |
| Vision | VISION SERVICE PLAN | 117 | $17K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $56K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 50 | $21K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $56K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.