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| Provider | Services | Address | Compensation |
|---|---|---|---|
| GILSBAR, INC. EIN 72-0519951 SERVICE PROVIDER | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $79K |
| CIGNA HEALTHCARE EIN 59-1031071 SERVICE PROVIDER | Insurance services Service code 23 | — | $62K |
| PAUL'S INSURANCE AGENCY EIN 72-0487865 BROKER | Insurance agents and brokers Service code 22 | — | $44K |
| MEDCOM EIN 72-1339762 SERVICE PROVIDER | Insurance services Service code 23 | — | $25K |
| INTERFACE EAP EIN 76-0280809 SERVICE PROVIDER | Insurance services Service code 23 | — | $11K |
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 | 369 | 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) | 369 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INURANCE COMPANY | 369 | $567K |
| Dental | STANDARD INSURANCE COMPANY | 313 | $202K |
| Vision | STANDARD INSURANCE COMPANY | 229 | $35K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 423 | $217K |
| Short-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 420 | $207K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 320 | $137K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INURANCE COMPANY | 369 | $567K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 423 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 423 | — |
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.