| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIM LEAKE3 | 3033 NW 63RD ST, STE 208 EAST OKLAHOMA CITY, OK 73116 | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | $53K | — | $53K | 10.59% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES | 3810 E. SUNSHINE ST, STE 200 SPRINGFIELD, MO 65809 | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | $27K | — | $27K | 5.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CERTUS MANAGEMENT EIN 35-2060150 STOP LOSS INS CARRIER | Other fees Service code 99 | 300 N. MERIDIAN ST, STE 1710 INDIANAPOLIS, IN 46204 | $501K |
| GROUP BENEFIT SERVICES EIN 43-1770779 BROKER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance agents and brokers; Recordkeeping fees; Account maintenance fees; Claims processing; Insurance brokerage commissions and fees Service code 12 | 3810 E. SUNSHINE ST, STE 200 SPRINGFIELD, MO 65809 | $120K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 PPO NETWORK | Other fees; Other services; Direct payment from the plan Service code 49 | 29742 NETWORK PLACE CHICAGO, IL 60673 | $67K |
| TIM LEAKE BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 3033 NW 63RD ST, STE 208 EAST OKLAHOMA CITY, OK 73116 | $53K |
| MULTIPLAN EIN 13-3068979 PPO NETWORK | Direct payment from the plan; Other services Service code 49 | 3345 MICHELSON DR, STE 200 IRVINE, CA 92612 | $7K |
| AMERICAN HEALTH HOLDING, INC EIN 31-1368946 MEDICAL REVIEW | Consulting (general); Direct payment from the plan Service code 16 | PO BOX 360142 PITTSBURGH, PA 15250 | $6K |
| NOVANET, INC. EIN 58-2106226 PPO NETWORK | Other services; Direct payment from the plan Service code 49 | 3500 PARKWAY LANE, STE 440 NORCROSS, GA 30092 | $6K |
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 | 210 | 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) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | 210 | $531K |
| Dental | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | 210 | $501K |
| Vision | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | 210 | $501K |
| Prescription drug(2 contracts, 2 carriers) | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | 210 | $531K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | CERTUS MANAGEMENT/ SIRIUS AMERICA INSURANCE | 210 | $531K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.