| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | ONE ALAMO CENTER 106 S ST MARY ST S SAN ANTONIO, TX 78205 | GUARDIAN | $21K | — | $21K | 3.49% |
| IMAGINE3603 | 12770 MERIT DRIVE DALLAS, TX 75251 | TOKIO MARINE HCC | $6K | $2K | $8K | 13.60% |
| AMERICAN LIFE & CASUALTY3 Filed as: AMERICAN LIFE AND CASUALTY MAR | 11825 PENNSYLVANIA ST CARMEL, IN 46032 | CONSECO | $141 | — | $141 | 3.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER VOLUNTARY BENEFITS L | 1850 LOCKHILL SELMA SUITE 101 SAN ANTONIO, TX 78213 | CONSECO | $91 | — | $91 | 2.37% |
| CHARLES M. DAVIS3 | 127 CALAIS WAY SHAVANO PARK, TX 78249 | CONSECO | $86 | — | $86 | 2.24% |
| HOME OFFICE-COMMISSION BUYOUT3 | 11825 PENNSYLVANIA ST CARMEL, IN 46032 | CONSECO | $48 | — | $48 | 1.25% |
| PERFORMANCE MATTERS ASSOCIATES3 | 11825 PENNSYLVANIA ST CARMEL, IN 46032 | CONSECO | $46 | — | $46 | 1.20% |
| JAMES M. ANDERSON3 | 1238 CHINKAPIN PL FLOWER MOUND, TX 75028 | CONSECO | $34 | — | $34 | 0.88% |
| INSURANCE RECEIVABLES 6. LLC.3 | 8888 KEYSTONE CROSSING STE 1700 INDIANAPOLIS, IN 46240 | CONSECO | $33 | — | $33 | 0.86% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 18TH ST S BIRMINGHAM, AL 35233 | CONSECO | $30 | — | $30 | 0.78% |
| CHARLES M. DAVIS3 | 13007 PRINCE FOREST CT SAN ANTONIO, TX 78230 | CONSECO | $26 | — | $26 | 0.68% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 18TH ST S BIRMINGHAM, AL 35233 | CONSECO | $26 | — | $26 | 0.68% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: RICHARD S LEE | 555 BAYVIEW DRIVE BELLEAIR, FL 33756 | CONSECO | $8 | — | $8 | 0.21% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 18TH ST S BIRMINGHAM, AL 35233 | CONSECO | $5 | — | $5 | 0.13% |
| MICHAEL S DAVID3 | 5006 ABERDEEN PKWY AMARILLO, TX 79119 | CONSECO | $4 | — | $4 | 0.10% |
| JAMES PERRY ZANDER3 Filed as: JAMES M. HOBBS | 4141 SAN CARLOS ST DALLAS, TX 75205 | CONSECO | $1 | — | $1 | 0.03% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 8TH ST S BIRMINGHAM, AL 35233 | CONSECO | $1 | — | $1 | 0.03% |
| PAUL GRIFFIN3 | 12025 HUNTERS LAKE DR NEW PRT RCHY, FL 34654 | CONSECO | $0 | — | $0 | 0.00% |
| NICKOLAS RADIVOYEVITCH3 | 1840 W 28TH STREET, APT 17 CLEVELAND, OH 44113 | CONSECO | $0 | — | $0 | 0.00% |
| LINDA TEETS3 | 5905 LOST OAKS DRIVE CARMEL, IN 46033 | CONSECO | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP & PENSION ADMINISTRATORS, INC EIN 75-1617587 BENEFIT ADMINISTRATOR | Other services; Claims processing Service code 12 | — | $209K |
| FORVIS LLP EIN 44-0160260 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $20K |
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 | 630 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 630 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $940 |
| Dental | GUARDIAN | 630 | $595K |
| Vision | GUARDIAN | 630 | $595K |
| Life insurance | GUARDIAN | 630 | $595K |
| Short-term disability | GUARDIAN | 630 | $595K |
| Long-term disability | GUARDIAN | 630 | $595K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE | 512 | $530K |
| Other(2 contracts, 2 carriers) | TOKIO MARINE HCC | 409 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 630 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.