| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INS AGENCY3 Filed as: GBS INSURANCE AGENCY | RICHARD K FIELDING 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $37K | — | $37K | 12.16% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFITS INSURANCE | 465 S 400 E SUITE 300 SALT LAKE CITY, UT 84111 | PRUDENTIAL | $6K | — | $6K | 5.53% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL | — | $39 | $39 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE EIN 59-1031071 SERVICE PROVIDER | Direct payment from the plan; Claims processing Service code 12 | — | $80K |
| AMERICA SPECIALITY HEALTH SERVICE PROVIDER | Participant communication; Float revenue; Other services; Non-monetary compensation; Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary Service code 12 | 10221 WATERIDGE CIRCLE SUITE 201 SAN DIEGO, CA 92121 | $0 |
| CARECORE DBA EVICORE SERVICE PROVIDER | Named fiduciary; Participant communication; Contract Administrator; Claims processing; Float revenue; Non-monetary compensation; Other services; Direct payment from the plan Service code 12 | 400 BUCKWALTER PLACE BLVD BLUFFON, SC 29910 | $0 |
| CIGNA HEALTH & LIFE INSURANCE | Direct payment from the plan; Claims processing; Named fiduciary; Contract Administrator; Non-monetary compensation; Other services; Participant communication; Float revenue Service code 12 | — | $0 |
| CIGNA HEALTH REWARDS VENDORS SERVICE PROVIDER | Named fiduciary; Participant communication; Other services; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Float revenue; Claims processing Service code 12 | 4000 LUXOTTICA PLACE MASON, OH 45040 | $0 |
| MEDSOLUTIONS DBA EVICORE, INC SERVICE PROVIDER | Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Float revenue; Participant communication; Claims processing; Named fiduciary Service code 12 | 730 COOL SPRINGS BLVD, #800 FRANKLIN, TN 37067 | $0 |
| US BANK NATIONAL ASSOCIATION SERVICE PROVIDER | Direct payment from the plan; Claims processing; Float revenue; Participant communication; Named fiduciary; Contract Administrator; Non-monetary compensation; Other services Service code 12 | 800 NICHOLLET MALL MINNEAPOLIS, MN 55402 | $0 |
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 | 101 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 163 | $304K |
| Life insurance | PRUDENTIAL | 165 | $109K |
| Other | PRUDENTIAL | 165 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.