| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 11 CONTINENTAL DR STE 405 NEWARK, DE 19713 | PRINCIPAL LIFE INSURANCE COMPANY | $18K | $14K | $31K | 13.26% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR STE 200 HUNT VALLEY, MD 21030 | PRINCIPAL LIFE INSURANCE COMPANY | — | $7K | $7K | 2.93% |
| MULTIPLE BROKERS (SEE APPENDIX)3 Filed as: MULTIPLE BROKER (SEE APPENDIX) | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $546 | — | $546 | 4.94% |
| ROBERT H. ROTH4 Filed as: ROBERT ROTH JR | 9 DEARBORN LN BEAR, DE 19701 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $2K | — | $2K | 36.41% |
| MICHAEL S SCHWARTZ2 | 34 DRYDEN RD NEW CASTLE, DE 19720 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $51 | — | $51 | 1.18% |
| MULTIPLE BROKERS (SEE APPENDIX)3 | PO BOX 1365 COLUMBIA, SC 29202 | THE PAUL REVERE LIFE INSURANCE COMPANY | $414 | $1K | $1K | 159.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 STOP LOSS ADMIN FEES | Contract Administrator Service code 13 | — | $282K |
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 | 214 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 214 | $237K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 214 | $237K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 214 | $237K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 214 | $237K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 214 | $237K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 33 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 214 | — |
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.