| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | ONE WACHOVIA CENTER 301 S. COLLEGE ST CHARLOTTE, NC 28202 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $2K | $3K | 10.61% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 7.97% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS INC. | 333 N INDIAN HILL BLVD CLAREMONT, CA 91711 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $37 | — | $37 | 0.12% |
| NIKKI PECORINO3 Filed as: NIKKI J PECORINO | 1650 HANOVER DR RENO, NV 89523 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 14.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CDS GROUP HEALTH EIN 88-2020496 TPA VENDOR | Claims processing Service code 12 | 1625 E PRATER WAY BLDG. C, SUITE 101 SPARKS, NV 89434 | $36K |
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 | 79 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 96 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $32K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $32K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | COMPANION | 96 | $217K |
| Other(3 contracts, 3 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 95 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 96 | — |
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.