| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HERBERT W. MONTOYA3 | 236 PONTE VEDRA PARK DRIVE, STE 101 PONTE VEDRA BEACH, FL 320826619 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $39K | — | $39K | 2.56% |
| HERBERT W. MONTOYA3 | 236 PONTE VEDRA PARK DRIVE, STE 101 PONTE VEDRA BEACH, FL 320826619 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $13K | — | $13K | 11.70% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET, 5TH FLOOR WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $8K | — | $8K | 7.00% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 236 PONTE VEDRA PARK DRIVE, STE 101 PONTE VEDRA BEACH, FL 320826619 | HUMANA INSURANCE COMPANY OF NE | $1K | — | $1K | 9.98% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 236 PONTE VEDRA PARK DRIVE, STE 101 PONTE VEDRA BEACH, FL 320826619 | HUMANA/COMPBENEFITS COMPANY | $695 | — | $695 | 9.88% |
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 | 218 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 394 | $1.5M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 394 | $1.5M |
| Vision(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY OF NE | 127 | $18K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 218 | $107K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 218 | $107K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 218 | $107K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 218 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 394 | — |
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.