| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 10425 SOUTH 82ND EAST AVENUE SUITE 110 TULSA, OK 74133 | UNITEDHEALTHCARE INSURANCE COMPANY | $43K | — | $43K | 4.47% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRANDS RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $987 | $0 | $987 | 0.10% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION INSURANCE SERVICES, INC. | 10425 SOUTH 82ND EAST AVENUE SUITE 110 TULSA, OK 74133 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $544 | $544 | 0.06% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 2290 HUNTINGTON DRIVE, SUITE 200 SAN MARINO, CA 91108 | PRINCIPAL LIFE INSURANCE COMPANY | $23K | $145 | $23K | 18.17% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2625 WEST PETERSON AVENUE CHICAGO, IL 60659 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | -$145 | -$145 | -0.11% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 10425 SOUTH 82ND EAST AVENUE SUITE 110 TULSA, OK 74133 | DELTA DENTAL PLAN OF ARKANSAS | $4K | $0 | $4K | 6.31% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 10425 SOUTH 82ND EAST AVENUE SUITE 110 TULSA, OK 74133 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 20.00% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 80 SOUTH LAKE AVENUE, SUITE 600 PASADENA, CA 91101 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
No Schedule C service providers reported on this filing.
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 228 | $953K |
| Dental | DELTA DENTAL PLAN OF ARKANSAS | 266 | $70K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 147 | $17K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 296 | $128K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 296 | $128K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 296 | $128K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 296 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 296 | — |
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.