| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STONE MOUNTAIN3 Filed as: STONE MOUNTAIN RISK LLC | 5636 FORD STREET NORWALK, IA 502110000 | ROSCOMMON INSURANCE COMPANY | $66K | $0 | $66K | 27.34% |
| ASSURED BENEFITS ADMINISTRATORS3 Filed as: ASSURED BENEFIT ADMINISTRATORS | 221 N. KANSAS ST. STE 1610 EL PASO, TX 799010000 | ROSCOMMON INSURANCE COMPANY | $45K | $0 | $45K | 18.60% |
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY AND ASSOCIATES LLC | PO BOX 441 DES MOINES, IA 803020441 | ROSCOMMON INSURANCE COMPANY | $35K | $0 | $35K | 14.47% |
| TOBY HEALTH PLANS LLC3 | 3435 SINCA ST STE C ENGLEWOOD, CO 801100000 | ROSCOMMON INSURANCE COMPANY | $22K | $0 | $22K | 9.09% |
| INDEPENDENT MEDICAL SYSTEMS3 | 12221 MERIT DR STE 1800 DALLAS, TX 752512292 | ROSCOMMON INSURANCE COMPANY | $6K | $0 | $6K | 2.58% |
| MEDICAL REVIEW INC3 | PO BOX 20908 LOUSVILLE, KY 402500908 | ROSCOMMON INSURANCE COMPANY | $6K | $0 | $6K | 2.40% |
| HEALTH ROSETTA GROUP PBC3 | 3019 NE 127TH ST #27633 SEATTLE, WA 981652969 | ROSCOMMON INSURANCE COMPANY | $5K | $0 | $5K | 2.07% |
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY AND ASSOCIATES | PO BOX 9207 DES MOINES, IA 50306 | HARTFORD LIFE AND ACCIDENT | $16K | $5K | $21K | 22.37% |
| AVANT SPECIALTY BENEFITS LLC3 | 1828 WALNUT ST STE 801 KANSAS CITY, MO 64108 | HARTFORD LIFE AND ACCIDENT | $0 | $2K | $2K | 1.77% |
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY AND ASSOCIATES | 13810 FNB PARKWAY STE 300 OMAHA, NE 68154 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 12.00% |
| C2 CENTRIC LLC3 | 11740 SW 68TH PARKWAY STE 2 PORTLAND, OR 97223 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $56 | $565 | $621 | 0.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BEST IN CLASS EIN 38-3953777 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 195 N HARBOR DR. APT 3401 CHICAGO, IL 606017533 | $7K |
| HOLMES MURPHY AND ASSOCIATES LLC EIN 42-0985055 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 2727 GRAND PRAIRIE PKWY WAUKEE, ID 502638844 | $7K |
| MULTIPLAN INC EIN 13-3068979 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | PO BOX 29380 NEW YORK, NY 100879380 | $2K |
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 | 605 | 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. |
| Total participants (= "Plan participants" tile) | 605 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROSCOMMON INSURANCE COMPANY | 83 | $242K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $85K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $85K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 599 | $95K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 599 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 599 | — |
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.