| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACK EARP3 | PO BOX 1129 GLADEWATER, TX 756471129 | DALLAS RISK MANAGEMENT LLC | $16K | — | $16K | 4.59% |
| JACK EARP3 | PO BOX 1129 GLADEWATER, TX 756471129 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $44K | — | $44K | 14.59% |
| DOMINIC RODRIGUEZ3 | 17611 BELWOOD PARK LANE CYPRESS, TX 77433 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 3.60% |
| TAILORED WORKSITE SERVICES | 1802 LAKE MEADOWS CT HOUSTON, TX 77077 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 3.60% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 0.95% |
| JACK EARP3 | PO BOX 1129 GLADEWATER, TX 756471129 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 14.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED BENEFITS ADMINISTRATORS NONE | Direct payment from the plan; Contract Administrator Service code 13 | 221 N KANSAS ST STE 1610 EL PASO, TX 79901 | $42K |
| HCC LIFE INSURANCE COMPANY EIN 35-1817054 NONE | Direct payment from the plan; Insurance services Service code 23 | 6000 FELDWOOD RD BOX 402032 COLLEGE PARK, GA 30349 | $30K |
| VOLTAIRE HEALTH LLC DBA PAYER COMPA EIN 46-2047081 NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 5800 GRANITE PARKWAY STE 450 PLANO, TX 45024 | $10K |
| MULTIPLAN INC EIN 13-3068979 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | PO BOX 29380 NEW YORK, NY 10087 | $9K |
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 | 225 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $301K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $301K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $301K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $301K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $301K |
| Stop-loss / reinsurancereinsurance | DALLAS RISK MANAGEMENT LLC | 163 | $342K |
| Other(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 229 | $360K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 229 | — |
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.