| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIBERTY COMPANY INSURANCE BROKERS3 | 21820 BURBANK BOULEVARD WOODLAND HILLS, CA 91367 | AETNA LIFE INSURANCE COMPANY | $28K | $0 | $28K | 4.49% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $9K | $9K | 5.00% |
| LIBERTY COMPANY INSURANCE BROKERS3 | 2905 PREMIERE PARKWAY, SUITE 285 DULUTH, GA 30097 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 1.84% |
| IWASYK INSURANCE SERVICES, LLC3 | 4419 CORKWOOD COURT CONCORD, CA 94521 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $15K | $20K | 72.33% |
| BRIAN ROBERT LLOYD3 Filed as: BRIAN ROBERT LIOYD | 6234 KINGS PEAK DRIVE EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $574 | $2K | $2K | 8.47% |
| LIBERTY COMPANY INSURANCE BROKERS3 | 5955 DE SOTO AVENUE WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 7.58% |
| ANDRES MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $692 | $2K | 6.23% |
| DANIEL J BAZIS3 Filed as: DANIEL J. BAZIS | 9218 SOUTH 168TH AVENUE CIRCLE OMAHA, NE 68136 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $21 | $32 | 0.11% |
| MS BENEFITS3 Filed as: MS BENEFITS, LLC | 100 CHALLENGER ROAD, SUITE 105 RIDGEFIELD PARK, NJ 07660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.08% |
| JENNIFER MCCLELLAN3 Filed as: JENNIFER MCCLELLAN AND OTHER AGENTS | 118 ROYAL HORSE WAY REINHOLDS, PA 17569 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
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 | 215 | 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) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 78 | $626K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $179K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $179K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $179K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $179K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $179K |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 78 | $626K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.