| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SULLIVAN INSURANCE AGENCY3 Filed as: SULLIVAN INSURANCE SERVICES | PO BOX 8705 201 GREENVILLE, WA 75404 | UNUM | $5K | $0 | $5K | 4.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSMART BENEFIT SOLUTIONS EIN 75-1857307 | Contract Administrator Service code 13 | — | $490K |
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 | Contract Administrator Service code 13 | — | $466K |
| SULLIVAN INSURANCE AGENCY | Insurance agents and brokers Service code 22 | PO BOX 8705 GREENVILLE, TX 75404 | $85K |
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 | 1,332 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,332 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM | 1,341 | $122K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 1,267 | $529K |
| Other | UNUM | 1,341 | $122K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,341 | — |
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.