| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUTHERFORD FINANCIAL SERVICES INC.3 | 5605 CARNEGIE BLVD STE 300 CHARLOTTE, SC 28209 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $5K | — | $5K | 7.86% |
| RUTHERFORD FINANCIAL SERVICES INC.3 | 6230 FAIRVIEW RD STE 230 CHARLOTTE, NC 29210 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $863 | — | $863 | 1.31% |
| MARSH & MCLENNAN AGENCY LLC3 | 2301 SUGAR BUSH ROAD, SUITE 220 RALEIGH, NC 27612 | ALLSTATE BENEFITS | $1K | — | $1K | 6.93% |
| PLAN BENEFIT SERVICES INC3 Filed as: PLAN BENEFIT SERVICES INC. | PO BOX 2307 COLUMBIA, SC 292022307 | ALLSTATE BENEFITS | $1K | — | $1K | 6.63% |
| RUTHERFORD FINANCIAL SERVICES INC.3 | PO BOX 12748 ROANOKE, VA 24028 | ALLSTATE BENEFITS | $511 | — | $511 | 2.75% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 185 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | 179 | $851K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 205 | $10K |
| Life insurance | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 185 | $66K |
| Short-term disability | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 185 | $66K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 185 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.