| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INSURANCE SERVICES | 26465 CARMEL RANCHO BLVD., #1 CARMEL, CA 93923 | BLUE SHIELD OF CALIFORNIA | $129K | $19K | $148K | 5.73% |
| KERR, WELDON G3 Filed as: KERR, WELDON G. | 6155 ALMADEN EXPWY, #210 RBG SAN JOSE SAN JOSE, CA 95120 | BLUE SHIELD OF CALIFORNIA | $51K | — | $51K | 2.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 N. 40TH STREET, #234 PHOENIX, AZ 85018 | BLUE SHIELD OF CALIFORNIA | $30K | — | $30K | 1.16% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INSURANCE SERVICES | 26465 CARMEL RANCHO BLVD., #1 CARMEL, CA 93923 | BLUE SHIELD OF CALIFORNIA | — | $66 | $66 | 0.00% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INSURANCE SERVICES | P. O. BOX 222634 CARMEL, CA 939222634 | HUMANA DENTAL INSURANCE COMPANY | $29K | $1K | $30K | 10.23% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INSURANCE SERVICES | P. O. BOX 222634 CARMEL, CA 939222634 | VISION SERVICE PLAN | $2K | — | $2K | 3.67% |
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 | 253 | 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) | 253 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 380 | $2.6M |
| Dental | HUMANA DENTAL INSURANCE COMPANY | 338 | $291K |
| Vision | VISION SERVICE PLAN | 317 | $52K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 380 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 380 | — |
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.
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.