| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADVANCED INSURANCE SERVICES INC3 | 440 COBIA DRIVE UNIT 1501 KATY, TX 77494 | DENTAL SELECT | $876 | — | $876 | 9.75% |
| ADVANCED INSURANCE SERVICES INC3 | 440 COBIA DRIVE UNIT 1501 KATY, TX 77494 | NIPPON LIFE BENEFITS | $565 | — | $565 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STRATEGIC UNDERWRITING SOLUTIONS, L EIN 42-1144827 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $55K |
| SISCO SERVICES (MEDICAL/COBRA) EIN 42-1144827 THIRD PARTY ADMIN. | Contract Administrator Service code 13 | — | $23K |
| BENEFIT INDEMNITY CORP. EIN 66-0761417 AGENT/AGENCY | Insurance brokerage commissions and fees Service code 53 | — | $8K |
| ADVANCED INSURANCE SERVICES EIN 20-1843370 AGENT/AGENCY | Insurance brokerage commissions and fees Service code 53 | — | $7K |
| CIGNA EIN 84-0467907 PREFERRED PROV. NETWORK | Contract Administrator Service code 13 | — | $7K |
| BENEZON LLC EIN 47-5190646 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $2K |
| TELADOC HEALTH EIN 04-3750597 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $1K |
| MULTIPLAN EIN 13-3068979 PREFERRED PROV. NETWORK | Contract Administrator Service code 13 | — | $529 |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $0 |
| Dental | DENTAL SELECT | 26 | $9K |
| Vision | DENTAL SELECT | 26 | $9K |
| Life insurance | NIPPON LIFE BENEFITS | 120 | $4K |
| Other | NIPPON LIFE BENEFITS | 120 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.