| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS3 Filed as: ALWINS CONNECT INSURANCE SERVICES L | 1600 WEST HILLSDALE BLVD STE 201 SAN MATEO, CA 94402 | AETNA LIFE INSURANCE CO. | $20K | $0 | $20K | 1.30% |
| JN SAVASTA CORP3 Filed as: JN SAVASTA INC. | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | AETNA LIFE INSURANCE CO. | $20K | $0 | $20K | 1.30% |
| DONALD C SAVOY INC3 Filed as: DONALD C SAVOY INC. | 25B HANOVER RD FLORHAM PARK, NJ 07932 | AETNA LIFE INSURANCE CO. | $8K | $0 | $8K | 0.52% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 1500 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 10.27% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.30% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $948 | $948 | 2.15% |
| JN SAVASTA CORP3 Filed as: JN SAVASTA INC. | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | AETNA HEALTH, INC. | $403 | $0 | $403 | 1.10% |
| AMWINS3 Filed as: ALWINS CONNECT INSURANCE SERVICES L | 1600 WEST HILLDALE BLVD STE 201 SAN MATEO, CA 94402 | AETNA HEALTH, INC. | $388 | $0 | $388 | 1.06% |
| DONALD C SAVOY INC3 Filed as: DONALD C SAVOY INC. | 25B HANOVER RD FLORHAM PARK, NJ 07932 | AETNA HEALTH, INC. | $151 | $0 | $151 | 0.41% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 1500 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $3K | 9.98% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.46% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $767 | $767 | 2.23% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 1500 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $2K | 10.37% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $956 | $0 | $956 | 4.24% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $478 | $478 | 2.12% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 1500 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $906 | $2K | 10.36% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $835 | $0 | $835 | 4.24% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $417 | $417 | 2.12% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 150 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $923 | $738 | $2K | 10.33% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $686 | $0 | $686 | 4.26% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $343 | $343 | 2.13% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SERVICES L | 150 QUAIL ST STE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $227 | $221 | $448 | 9.39% |
| JN SAVASTA CORP3 Filed as: SAVASTA JN CORP | 1350 BROADWAY RM 410 NEW YORK, NY 10018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $200 | $0 | $200 | 4.19% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES INC. | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $100 | $100 | 2.10% |
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 | 274 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 283 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 274 | $1.5M |
| Dental | AETNA LIFE INSURANCE CO. | 274 | $1.5M |
| Vision | AETNA LIFE INSURANCE CO. | 274 | $1.5M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $5K |
| Other(6 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 274 | — |
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.