| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET NEWPORT BEACH, CA 92660 | AETNA LIFE INSURANCE COMPANY | $19K | $3K | $22K | 0.80% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.05% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS. SVCS. | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | $12K | $32K | 15.17% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOCIATES INS. GROUP INC | 1 KELLY WAY SPARKS, MD 21152 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $26K | $26K | 12.29% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 0.76% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | GUARDIAN | $6K | $3K | $10K | 14.31% |
| USI INSURANCE SERVICES LLC3 | 300 CORPORATE CENTER DRIVE SUITE 303 CAMP HILL, PA 17011 | GUARDIAN | $479 | $0 | $479 | 0.72% |
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 | 482 | 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) | 482 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 412 | $2.7M |
| Dental | AETNA LIFE INSURANCE COMPANY | 412 | $2.7M |
| Vision | AETNA LIFE INSURANCE COMPANY | 412 | $2.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 482 | $212K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 482 | $212K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 482 | $212K |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 412 | $2.7M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 482 | $279K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 482 | — |
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.