| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $124 | $124 | 0.02% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $12K | $104 | $12K | 16.24% |
| CHRISTA G AUFDEMBERG INC4 | 13102 BRITTANY WOODS DR TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 8.99% |
| WILLIS TOWERS WATSON US LLC4 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 18101 VON KARMAN AVE STE 600 IRVINE, CA 92612 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 5.81% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | POST OFFICE BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $450 | — | $450 | 11.43% |
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 | 652 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 685 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 462 | $8.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,278 | $668K |
| Vision | VISION SERVICE PLAN | 512 | $90K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 652 | $502K |
| Short-term disability(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 652 | $580K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 652 | $502K |
| Prescription drug | HEALTH NET | 462 | $8.4M |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 652 | $601K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,278 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.