| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | AETNA LIFE INSURANCE CO. | $10K | $5K | $15K | 1.03% |
| GBS BENEFITS INC3 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | AETNA LIFE INSURANCE CO. | — | $7K | $7K | 0.50% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 12.63% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DR ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GBS BENEFITS INC BROKER | Claims processing Service code 12 | 2200 S MAIN ST STE 600 SOUTH SALT LAKE, UT 84115 | $49K |
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 | 229 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 229 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 249 | $1.4M |
| Dental | AETNA LIFE INSURANCE CO. | 249 | $1.4M |
| Vision | AETNA LIFE INSURANCE CO. | 249 | $1.4M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $68K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $68K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.