| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 330 MADISON AVENUE, 7TH FLOOR NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $169 | $4K | 15.85% |
| WELLS FARGO INSURANCE SERVICES3 | 64 MONROE AVENUE NW, SUITE 300 GRAND RAPIDS, MI 49503 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY | — | $23 | $23 | 1.23% |
| WELLS FARGO INSURANCE SERVICES3 | 11017 COBBLEROCK DRIVE SUITE 100 RANCHO CORDOVA, CA 95670 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY | — | $13 | $13 | 0.69% |
| WELLS FARGO INSURANCE SERVICES3 | 330 MADISON AVENUE, 7TH FLOOR NEW YORK, NY 10017 | FOUR EVER LIFE INSURANCE COMPANY | $178 | — | $178 | 15.01% |
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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INSURANCE COMPANY | 142 | $1K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILLIATES | 142 | $127K |
| Vision | EYEMED VISION CARE | 109 | $7K |
| Other(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 12 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.