| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP & PENSION ADMINISTRATORS INC3 Filed as: GROUP & PENSION ADMINISTRATORS, INC | 12770 MERIT DR 2ND FLOOR DALLAS, TX 75251 | SUN LIFE ASSURANCE COMPANY OF CANADA - STOP LOSS | — | $10K | $10K | 1.28% |
| IMA, INC.3 Filed as: IMA, INC - DENTAL | PO BOX 2992 WICHITA, KS 672012992 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $1K | $4K | 5.15% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC | 175 S 3RD ST SUITE 800 COLUMBUS, OH 432155194 | METROPOLITAN LIFE INSURANCE COMPANY | $947 | — | $947 | 1.25% |
| IMA, INC.3 Filed as: IMA, INC - AMERITAS | 1705 17TH STREET100 DENVER, CO 80202 | AMERITAS | $7K | — | $7K | 17.55% |
| FRINGE INSURANCE BENEFITS, INC.3 Filed as: FRINGE INSURANCE BENEFITS | 11910 ANDRSON MILL ROAD STE 401 AUSTIN, TX 78726 | AMERITAS | $4K | — | $4K | 9.65% |
| IMA, INC.3 Filed as: IMA, INC - LIFE INS - CO | 1705 17TH ST SUITE 100 DENVER, CO 80202 | SUN LIFE ASSURANCE COMPANY OF CANADA - LIFE INSURANCE | $2K | — | $2K | 8.04% |
| IMA, INC.3 Filed as: IMA, INC - LIFE INS - KS | 8200 E 32ND ST NORTH WICHITA, KS 67226 | SUN LIFE ASSURANCE COMPANY OF CANADA - LIFE INSURANCE | — | $389 | $389 | 1.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP AND PENSION ADMINISTRATORS EIN 75-2148164 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | PARK CENTRAL B 12770 MERIT DR 2ND FLOOR SUITE 2 DALLAS, TX 75251 | $140K |
| IMA, INC. CONSULTANT | Consulting fees Service code 70 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | $60K |
| DIMICK GREEN BROWN & STARK PC EIN 73-1158890 CONTRACT ADMINSTRTR | Contract Administrator Service code 13 | 3717 NW 63RD STREET SUITE 100 OKLAHOMA CITY, OK 73116 | $29K |
| CASEY J. RUSSELL, CPA, INC. EIN 73-1349920 AUDITING | Accounting (including auditing) Service code 10 | 2812 NW 57TH STREET STE 102 OKLAHOMA CITY, OK 73112 | $8K |
| WORKER ASSISTANCE PROGRAM EIN 74-1847991 COUNSELING | Consulting (pension) Service code 17 | 2525 WALLINGWOOD DRIVE BLDG 5 AUSTIN, TX 78746 | $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 | 337 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,598 | $114K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,598 | — |
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.