| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAVERICK INSURANCE3 Filed as: MAVERICK BENEFITS | 4000 S. PROVIDENCE RD, BOX 12 COLUMBIA, MO 65203 | CARBON STOP LOSS | $25K | — | $25K | 7.60% |
| JM DEREN & ASSOCIATES3 | 2612 OAKWOOD PRESERVE DRIVE WESLEY CHAPEL, FL 33543 | CARBON STOP LOSS | $19K | — | $19K | 5.76% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES | 3810 E. SUNSHINE STREET, SUITE 200 SPRINGFIELD, MO 65809 | CARBON STOP LOSS | $16K | — | $16K | 5.00% |
| BIG TREE MEDICAL HOME3 | 200 CORPORATE LAKE DRIVE COLUMBIA, MO 65203 | CARBON STOP LOSS | $1K | — | $1K | 0.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| IOA RE EIN 23-2589410 STOP LOSS INS CARRIER | Other fees Service code 99 | 190 W. GERMANTOWN PIKE SUITE 200 E. NORRITON, PA 19401 | $326K |
| BIG TREE MEDICAL HOME EIN 82-2338518 DIRECT PRIMARY CARE | Direct payment from the plan; Other services Service code 49 | 200 CORPORATE LAKE DRIVE COLUMBIA, MO 65203 | $105K |
| GROUP BENEFIT SERVICES, INC. EIN 43-1770779 BROKER | Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance agents and brokers; Claims processing; Insurance brokerage commissions and fees; Account maintenance fees Service code 12 | 3810 E. SUNSHINE STREET, SUITE 200 SPRINGFIELD, MO 65809 | $92K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 STOP LOSS INS CARRIER | Other services; Direct payment from the plan; Other fees Service code 49 | 29742 NETWORK PLACE CHICAGO, IL 60673 | $29K |
| MAVERICK BENEFITS EIN 82-2338518 BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 4000 W. PROVIDENCE ROAD BOX 12 COLUMBIA, MO 65203 | $25K |
| J.M. DEREN & ASSOCIATES LLC BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 2612 OAKWOOD PRESERVE DRIVE WESLEY CHAPEL, FL 33543 | $19K |
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 | 20 | 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) | 20 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CARBON STOP LOSS | 20 | $332K |
| Prescription drug(2 contracts, 2 carriers) | CARBON STOP LOSS | 20 | $332K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 20 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.