| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INC3 | 465 S 400 E SUITE 300 SALT LAKE CITY, UT 84111 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 14.65% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGCY ASSOC LLC | 216 SOUTH 200 WEST CEDAR CITY, UT 84720 | HARTFORD LIFE AND ACCIDENT | — | $491 | $491 | 1.89% |
| BETA HEALTH ASSOCIATION3 Filed as: BETA HEALTH ASSOCIATION INC | C/O CARRARA PLACE 6200 S SYCRACUSE WAY STE 460 GREENWOOD VILLAGE, CO 80111 | METROPOLITAN LIFE INSURANCE COMPANY | $674 | $289 | $963 | 9.06% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFITS INSURANCE AGENCY | 465 S 400 E STE 300 SLALT LAKE CITY, UT 84111 | METROPOLITAN LIFE INSURANCE COMPANY | $674 | $241 | $915 | 8.61% |
| INS EXCHANGE LLC3 | 5 ROEHM CT WEST ORANGE, NJ 07052 | METROPOLITAN LIFE INSURANCE COMPANY | $289 | $482 | $771 | 7.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $143K |
| GBS BENEFITS INC EIN 87-0680571 BROKER | Other commissions Service code 55 | — | $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 | 316 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $11K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 465 | $26K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 339 | $534K |
| Other | HARTFORD LIFE AND ACCIDENT | 465 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 465 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.