| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIM LEAKE3 | 3033 NW 63RD ST STE 208 EAST OKLAHOMA CITY, OK 73116 | GERBER LIFE INSURANCE COMPANY | $37K | — | $37K | — |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 65804 | GERBER LIFE INSURANCE COMPANY | $18K | — | $18K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP BENEFIT SERVICES, INC. EIN 43-1770779 THIRD PARTY ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 1736 E SUNSHINE ST, STE 200 SPRINGFIELD, MO 65804 | $61K |
| THE SANDSTECH GROUP / CIGNA EIN 31-1418743 PPO NETWORK | Other fees Service code 99 | 1385 KEMPER MEADOW DRIVE CINCINNATI, OH 45240 | $33K |
| LINCOLN NATIONAL LIFE INSURANCE CO. EIN 22-0832760 LIFE INSURER | Other fees Service code 99 | 8801 INDIAN HILLS DRIVE OMAHA, NE 68114 | $16K |
| PHCS / MULTIPLAN EIN 13-3068979 PPO NETWORK | Other fees Service code 99 | 3345 MICHELSON DRIVE, STE 200 IRVINE, CA 92612 | $14K |
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 | 177 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GERBER LIFE INSURANCE COMPANY | 177 | $0 |
| Dental | GERBER LIFE INSURANCE COMPANY | 177 | $0 |
| Vision | GERBER LIFE INSURANCE COMPANY | 177 | $0 |
| Prescription drug | GERBER LIFE INSURANCE COMPANY | 177 | $0 |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 177 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.