| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GBS BENEFITS INC3 Filed as: GBS BENEFITS | 525 E 100 S #200 SALT LAKE CITY, UT 84111 | DELTA DENTAL | $2K | — | $2K | 1.66% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGCY | 216 S 200 W CEDAR CITY, UT 84720 | HARTFORD LIFE AND ACCIDENT | — | $6K | $6K | 5.00% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFITS INS | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 1.25% |
| GBS BENEFITS INC3 | 465 S 400 E STE 300 SALT LAKE CITY, UT 84111 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 9.11% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS, INC | 525 E 100 S #200 SALT LAKE CITY, UT 84102 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $155K |
| 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 | 199 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 506 | $123K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 488 | $22K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 196 | $120K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 196 | $120K |
| Other | HARTFORD LIFE AND ACCIDENT | 163 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 506 | — |
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.