| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MODERN BENEFITS SOLUTIONS INC3 Filed as: MODERN BENEFITS SOLUTIONS, INC. | 2414 SOUTH KATY COURT SPOKANE, WA 99224 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $2K | $21K | 11.01% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $2K | $12K | 6.28% |
| MODERN BENEFITS SOLUTIONS INC3 Filed as: MODERN BENEFITS SOLUTIONS, INC. | 2414 SOUTH KATY COURT SPOKANE, WA 99224 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $26K | $0 | $26K | 15.28% |
| PAYCOM PAYROLL LLC5 Filed as: PAYCOM PAYROLL, LLC | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $650 | $650 | 0.38% |
| MODERN BENEFITS SOLUTIONS INC3 Filed as: MODERN BENEFITS SOLUTIONS, INC. | 2414 SOUTH KATY COURT SPOKANE, WA 99224 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $240 | $0 | $240 | 1.04% |
| TONYA LANCASTER3 | 1090 HERSHEY DRIVE SE MARIETTA, GA 30062 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $40 | $0 | $40 | 0.17% |
| JORDAN D EMMANS3 Filed as: JORDAN EMMANS | 438 WEST 26TH AVENUE SPOKANE, WA 99203 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $39 | $0 | $39 | 0.17% |
| ALLEN TERRY KENNETH3 | 20930 EAST HAPPY TRAILS LANE OTIS ORCHARDS, WA 99027 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.04% |
| HOLLY HALL3 | 2662 EAST UPPER HAYDEN LAKE ROAD HAYDEN, ID 83835 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.04% |
| LISA HALL3 | 2542 EAST SUNDOWN DRIVE COEUR D ALENE, ID 83815 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.04% |
| WHITNEY POWELL3 | 1763 FIDDLERS RIDGE DRIVE FLEMING ISLAND, FL 32003 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.04% |
| MODERN BENEFITS SOLUTIONS INC3 Filed as: MODERN BENEFITS SOLUTIONS, INC. | 2414 SOUTH KATY COURT SPOKANE, WA 99224 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $159 | $0 | $159 | 3.00% |
| BRANDON PENKO3 Filed as: BRANDON T. PENKO | 4927 MAGNOLIA BEND DRIVE ROSHARON, TX 77583 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | $0 | $90 | 1.70% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN, INC. | PO BOX 9201 AUSTIN, TX 78766 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.15% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.15% |
No Schedule C service providers reported on this filing.
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 571 | $188K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 571 | $188K |
| Life insurance(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 307 | $199K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 307 | $171K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 307 | $171K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 307 | $171K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 571 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.