| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL B. KELLY INSURANCE3 | P. O. BOX 222634 CARMEL, CA 939222634 | METROPOLITAN LIFE INSURANCE COMPANY | $35K | — | $35K | 9.93% |
| AMWINS3 Filed as: LISI, LLC | 1600 W. HILLSDALE BLVD., #201 SAN MATEO, CA 944023766 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | — | $17K | 4.96% |
| MICHAEL B. KELLY INSURANCE3 | P. O. BOX 222634 CARMEL, CA 939222263 | VISION SERVICE PLAN | $2K | — | $2K | 3.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SYMETRA LIFE INSURANCE EIN 91-0742147 STOP LOSS | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | 777 108TH AVENUE NE SUITE 1200 BELLEVUE, WA 98004 | $500K |
| MICHAEL B. KELLY INSURANCE EIN 30-0540100 BROKER | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | P. O. BOX 222634 CARMEL, CA 93922 | $127K |
| COASTAL TPA EIN 77-0523382 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | P. O. BOX 80308 SALINAS, CA 93912 | $101K |
| ANTHEM BLUE CROSS EIN 95-3760980 CARRIER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | P. O. BOX 511300 LOS ANGELES, CA 90051 | $74K |
| WELLDYNE HOLDING CORPORATION EIN 83-0338400 RX PPO | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 14 | P. O. BOX 90369 LAKELAND, FL 33804 | $16K |
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 | 374 | 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) | 374 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 881 | $352K |
| Vision | VISION SERVICE PLAN | 374 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 881 | — |
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.