| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL T. LEAKE3 | 12001 WESTERN VIEW DRIVE OKLAHOMA CITY, OK 73162 | SIRIUS AMERICAN INSURANCE COMPANY | $28K | — | $28K | — |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 65804 | SIRIUS AMERICAN INSURANCE COMPANY | $14K | — | $14K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP BENEFIT SERVICES, INC. EIN 43-1770779 PLAN ADMINISTRATOR | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 65804 | $41K |
| PHCS MULTIPLAN EIN 13-3068979 PPO NETWORK | Other fees Service code 99 | 3345 MICHELSON DRIVE, STE 200 IRVINE, CA 92612 | $15K |
| FIRST HEALTH / AHA EIN 01-0660339 PPO NETWORK | Other fees Service code 99 | 9229 WARD PARKWAY, SUITE 300 KANSAS CITY, MO 64114 | $13K |
| MANAGED CARE CONCEPTS EIN 86-0799129 PRE CERT/MED REVIEW | Other fees Service code 99 | 416 DONNELL ORANGE, TX 76180 | $6K |
| NOVANET, INC. EIN 58-2106226 PPO NETWORK | Other fees Service code 99 | 3500 PARKWAY LANE SUITE 440 NORCROSS, GA 30092 | $5K |
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 | 179 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIRIUS AMERICAN INSURANCE COMPANY | 179 | $0 |
| Dental | SIRIUS AMERICAN INSURANCE COMPANY | 179 | $0 |
| Vision | SIRIUS AMERICAN INSURANCE COMPANY | 179 | $0 |
| Prescription drug | SIRIUS AMERICAN INSURANCE COMPANY | 179 | $0 |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICAN INSURANCE COMPANY | 179 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.