| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 2.98% |
| BENEFIT ADVISOR SERVICES GROUP LLC3 Filed as: BENEFIT ADVISOR SERVICES GRP | 1125 SANCTUARY PARKWAY STE 300 ATTN MARTIN JOHNSON ALPHARETTA, GA 30009 | HARTFORD LIFE AND ACCIDENT | $1K | $0 | $1K | 1.03% |
| USI INSURANCE SERVICES LLC3 | 261 MADISON AVE 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | $300 | $0 | $300 | 0.26% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SVCS INC. | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | HARTFORD LIFE AND ACCIDENT | — | $210 | $210 | 0.18% |
| THOMAS DANCO3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 6.60% |
| USI INSURANCE SERVICES LLC3 | NORTHEAST-NY METRO PO BOX 62939 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $978 | — | $978 | 1.70% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $978 | — | $978 | 1.70% |
| KEELER & ASSOCIATES3 | 211 S. 23RD STREET PLATTSMOUTH, NE 68048 | RELIASTAR LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.40% |
| THOMAS DANCO3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | RELIASTAR LIFE INSURANCE COMPANY | $2K | $0 | $2K | 6.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: CLARENCE GALLAGHER | 211 S. 23RD ST. PLATTSMOUTH, NE 68048 | RELIASTAR LIFE INSURANCE COMPANY | $298 | $0 | $298 | 0.95% |
| SHAWN J KEELER3 Filed as: SHAWN KEELER | 211 S. 23RD ST. PLATTSMOUTH, NE 68048 | RELIASTAR LIFE INSURANCE COMPANY | $298 | $0 | $298 | 0.95% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | VISION SERVICE PLAN (VSP) | $850 | $0 | $850 | 4.78% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN (VSP) | $197 | $0 | $197 | 1.11% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: TBG DANCO INSURANCE SERVICES | 11150 SANTA MONICA BLVD #800 LOS ANGELES, CA 90025 | DELTA DENTAL OF ILLINOIS | $3K | — | $3K | 38.22% |
| USI INSURANCE SERVICES LLC3 | — | DELTA DENTAL OF ILLINOIS | $570 | — | $570 | 6.71% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | NATIONAL UNION FIRE INSURANCE CO OF PITTSBURGH | $322 | — | $322 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 CLAIMS PROCESSING | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Contract Administrator Service code 12 | — | $87K |
| THE EMPLOYERS BENEFIT GROUP, LLC INSURANCE BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | $60K |
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 | 149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ILLINOIS | 115 | $8K |
| Vision | VISION SERVICE PLAN (VSP) | 92 | $18K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 145 | $114K |
| Short-term disability | RELIASTAR LIFE INSURANCE COMPANY | 117 | $32K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 145 | $58K |
| Stop-loss / reinsurancereinsurance | ANTHEM COMMUNITY INSURANCE COMPANY | 301 | $320K |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 145 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.