| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PLANNED ADMINISTRATORS, INC.5 | 17 TECHNOLOGY GROUP SUITE E2AG COLUMBIA, SC 29203 | BCS INSURANCE COMPANY | — | $21K | $21K | 14.50% |
| INSURANCE APPLICATIONS GROUP3 | 250 COMMONWEALTH SUITE 107 GREENVILLE, SC 29615 | BCS INSURANCE COMPANY | $15K | — | $15K | 10.35% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA & ASSOCIATES | 236 PONTE VEDRA PARK DRIVE SUITE 101 PONTE VEDRA BEACH, FL 32082 | BCS INSURANCE COMPANY | $7K | — | $7K | 5.00% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE COMPANY | $12K | — | $12K | 10.00% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | NATIONWIDE LIFE INSURANCE COMPANY | $4K | — | $4K | 3.40% |
| ASSURANCE AGENCY LTD3 | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | AMERITAS | $7K | — | $7K | 10.00% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | AMERITAS | $4K | — | $4K | 5.50% |
| PLANNED ADMINISTRATORS, INC.5 | 17 TECHNOLOGY CIRCLE SUITE E2AG COLUMBIA, SC 29203 | BCS INSURANCE COMPANY | — | $6K | $6K | 14.50% |
| INSURANCE APPLICATIONS GROUP3 | 250 COMMONWEALTH SUITE 107 GREENVILLE, SC 29615 | BCS INSURANCE COMPANY | $4K | — | $4K | 10.54% |
| MONTOYA AND ASSOCIATES LLC5 Filed as: MONTOYA & ASSOCIATES | 236 PONTE VEDRA PARK DR. SUITE 101 PONTE VEDRA BEACH, FL 32082 | BCS INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| PLANNED ADMINISTRATORS, INC.3 | 17 TECHNOLOGY CIRCLE SUITE E2AG COLUMBIA, SC 29203 | BCS INSURANCE COMPANY | — | $2K | $2K | 14.50% |
| INSURANCE APPLICATIONS GROUP5 | 250 COMMONWEALTH SUITE 107 GREENVILLE, SC 29615 | BCS INSURANCE COMPANY | $1K | — | $1K | 10.59% |
| MONTOYA AND ASSOCIATES LLC5 Filed as: MONTOYA & ASSOCIATES | 236 PONTE VEDRA PARK DR. SUITE 101 PONTE VEDRA BEACH, FL 32082 | BCS INSURANCE COMPANY | $679 | — | $679 | 5.00% |
| PLANNED ADMINISTRATORS, INC.5 | 17 TECHNOLOGY CIRCLE SUITE E2AG COLUMBIA, SC 29203 | 4 EVER LIFE INSURANCE COMPANY | — | $2K | $2K | 14.50% |
| INSURANCE APPLICATIONS GROUP3 | 250 COMMONWEALTH SUITE 107 GREENVILLE, SC 29615 | 4 EVER LIFE INSURANCE COMPANY | $1K | — | $1K | 10.58% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA & ASSOCIATES | 236 PONTE VEDRA PARK DR. SUITE 101 PONTE VEDRA BEACH, FL 32082 | 4 EVER LIFE INSURANCE COMPANY | $581 | — | $581 | 5.00% |
| FRINGE INSURANCE BENEFITS, INC.5 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | NATIONWIDE LIFE INSURANCE COMPANY | — | $14K | $14K | 329.23% |
| ASSURANCE AGENCY LTD3 | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE COMPANY | — | $12K | $12K | 274.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TALL TREE ADMINISTRATORS EIN 87-0672300 N/A | Contract Administrator Service code 13 | 11550 S. 700 E. STE 200 DRAPER, UT 84020 | $56K |
| CONNECTICUT GENERAL LIFE (CIGNA) EIN 06-0303370 N/A | Contract Administrator; Claims processing Service code 12 | P.O. BOX 645014 CINCINNATI, OH 45264 | $31K |
| CORECARE, INC. EIN 47-5025831 N/A | Other services Service code 49 | 631 RIVER HIGHLANDS BLVD. STE A COVINGTON, LA 70433 | $11K |
| EBS, INC. EIN 81-0791425 N/A | Contract Administrator Service code 13 | 81 MEYERSVILLE ROAD CHATHAM, NJ 07928 | $8K |
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 | 442 | 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) | 442 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCS INSURANCE COMPANY | 193 | $144K |
| Dental(2 contracts, 2 carriers) | AMERITAS | 442 | $104K |
| Vision(2 contracts, 2 carriers) | AMERITAS | 442 | $79K |
| Life insurance(2 contracts, 2 carriers) | NATIONWIDE LIFE INSURANCE COMPANY | 141 | $131K |
| Short-term disability(2 contracts, 2 carriers) | NATIONWIDE LIFE INSURANCE COMPANY | 141 | $131K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 169 | $4K |
| Other | NATIONWIDE LIFE INSURANCE COMPANY | 141 | $120K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 442 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.