| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEVIN G GARRY CHFC CLU3 | PO BOX 399 121 N MAIN SALEM, SD 570580399 | NEW YORK LIFE INS AND ANN CORP | $68 | $0 | $68 | — |
| STEVEN J GARRY CLU CHFC MSFS3 | 5015 S WESTERN AVENUE SUITE 250 SIOUX FALLS, SD 571082646 | NEW YORK LIFE INS AND ANN CORP | $19 | $0 | $19 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRINCIPAL LIFE INSURANCE COMPANY EIN 42-0127290 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Participant loan processing; Recordkeeping fees Service code 13 | — | $3K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 SERVICES PROVIDED | Direct payment from the plan; Recordkeeping fees; Other services; Sub-transfer agency fees; Distribution (12b-1) fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $0 |
| WILSHIRE ASSOCIATES INC. EIN 95-2755361 INVESTMENT ADVISORY | Other investment fees and expenses; Investment advisory (plan) Service code 27 | — | $0 |
| WILSHIRE ASSOCIATES, INC | Investment advisory (plan); Other investment fees and expenses Service code 27 | — | $0 |
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 | 133 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(3 contracts, 2 carriers) | NEW YORK LIFE INS AND ANN CORP | 147 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 147 | — |
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.