| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SALT LAKE CITY, UT 84115 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 1.55% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | ATTN ACCOUNTING DEPT. 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 3.64% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY ASSOCIATION | PO BOX 130 CEDAR CITY, UT 84721 | PRINCIPAL LIFE INSURANCE COMPANY | — | $5K | $5K | 2.73% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | ACCOUNTING DEPT. 6143 S WILLOW DR. STE 200 GREENWOOD VILLAGE, CO 80111 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 2.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 SERVICE PROVIDER | Non-monetary compensation; Claims processing; Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Float revenue; Participant communication Service code 12 | — | $28K |
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 | 188 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 189 | $646K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $174K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $174K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $174K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $174K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.