| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON, SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $32K | — | $32K | 5.00% |
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON, SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $25K | — | $25K | 5.00% |
| HM LIFE INSURANCE COMPANY3 | 120 FIFTH AVENUE PITTSBURG, PA 15222 | HM LIFE INSURANCE COMPANY | $25K | — | $25K | 10.00% |
| KYSAR INSURANCE AGENCY INC3 Filed as: KYSAR INSURANCE AGENCY INC. | 300 W. ARRINGTON FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | — | $10K | 5.00% |
| MGIS3 | 10 WEST BROADWAY, SUITE 800 SALT LAKE CITY, UT 841012100 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $180 | $180 | 0.09% |
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON ST. STE. 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | — | $0 | 0.00% |
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON, SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 5.00% |
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 | 1,501 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,505 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW MEXICO | 4,039 | $1.4M |
| Vision | HM LIFE INSURANCE COMPANY | 3,770 | $251K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,708 | $503K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,706 | $59K |
| Long-term disability(3 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,710 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,039 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.