| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | UNITEDHEALTHCARE INSURANCE COMPANY | $86K | — | $86K | 3.26% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $3K | $11K | 5.55% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 2.80% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 4.04% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $652 | — | $652 | 10.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 5905 EAST GALBRAITH RD SUITE 5000 CINCINNATI, OH 45236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE, SUITE 780 FOSTER CITY, CA 94404 | $20K |
| FIDUCIARY PLAN MANAGEMENT SERVICES EIN 46-3922133 NONE | Accounting (including auditing); Trustee (directed) Service code 10 | 1 ALMADEN BLVD, SUITE 620 SAN JOSE, CA 95113 | $8K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 374 | $2.9M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 532 | $423K |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 532 | $423K |
| Life insurance(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 617 | $13K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 400 | $150K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 151 | $131K |
| Other(5 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 617 | $238K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 617 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.