| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTH FIRST TPA3 | P O BOX 130187 TYLER, TX 75713 | INTERNATIONAL SPECIALTY UNDERWRITERS | $287K | — | $287K | 74.93% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $6K | — | $6K | 11.06% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $910 | $6K | 17.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTERNATIONAL SPECIALTY UNDERWRITER EIN 57-0523959 NONE | Consulting (general) Service code 16 | 6621 SOUTHPOINT DRIVE NORTH SUITE 325 JACKSONVILLE, FL 32216 | $383K |
| HEALTHFIRST TPA EIN 75-2348381 TPA | Contract Administrator Service code 13 | PO BOX 130187 TYLER, TX 757130187 | $154K |
| UNITED HEALTH CARE NONE | Consulting (general) Service code 16 | PO BOX 30541 SALT LAKE CITY, UT 841300541 | $115K |
| SUPERIOR VISION EIN 75-2631278 NONE | Consulting (general) Service code 16 | PO BOX 841135 DALLAS, TX 752841135 | $54K |
| WELLNESS WORKS EIN 75-2850143 NONE | Consulting (general) Service code 16 | PO BOX 6307 TYLER TX, TX 75711 | $24K |
| ACCESS DIRECT EIN 75-2850142 NONE | Consulting (general) Service code 16 | PO BOX 130549 TYLER, TX 757130549 | $16K |
| MM SOLUTIONS EIN 75-2850143 NONE | Consulting (general) Service code 16 | PO BOX 6307 TYLER, TX 75711 | $7K |
| CONEXIS EIN 75-2764516 NONE | Consulting (general) Service code 16 | PO BOX 6241 ORANGE, CA 928636242 | $3K |
| PHCS EIN 04-3138814 NONE | Consulting (general) Service code 16 | PO BOX 29380 NEW YORK, NY 100879380 | -$6 |
| TELEDOC EIN 04-3705970 NONE | Consulting (general) Service code 16 | 17304 PRESTON RD STE 73 DALLAS, TX 75252 | -$6 |
| SYMETRA EIN 91-0742147 NONE | Consulting (general) Service code 16 | P O BOX 1491 MINNEAPOLIS, MN 554801491 | -$519 |
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 | 524 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INTERNATIONAL SPECIALTY UNDERWRITERS | 524 | $383K |
| Dental | INTERNATIONAL SPECIALTY UNDERWRITERS | 524 | $383K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 867 | $54K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 521 | $35K |
| Prescription drug | INTERNATIONAL SPECIALTY UNDERWRITERS | 524 | $383K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 521 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 867 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.