| 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 | $25K | — | $25K | 2.17% |
| LEAVITT GROUP3 Filed as: KYSAR MILLENIUM LEAVITT INSURANCE | 300 W. ARRINGTON ST. SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $22K | — | $22K | 1.87% |
| HM LIFE INSURANCE COMPANY3 | 120 FIFTH AVENUE PITTSBURGH, PA 15222 | HM LIFE INSURANCE COMPANY | $26K | — | $26K | 10.00% |
| LEAVITT GROUP3 Filed as: KYSAR MILLENNIUM LEAVITT INSURANCE | 300 W. ARRINGTON SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 2.51% |
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON , SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 2.49% |
| MGIS3 | 10 WEST BROADWAY, SUITE 800 SALT LAKE CITY, UT 841012100 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $180 | $180 | 0.08% |
| KYSAR INSURANCE AGENCY INC3 | 300 W. ARRINGTON, SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 2.25% |
| LEAVITT GROUP3 Filed as: KYSAR MILLENIUM LEAVITT INSURANCE | 300 W. ARRINGTON ST. SUITE 100 FARMINGTON, NM 87401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 1.84% |
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 | 1,658 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,676 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW MEXICO | 4,383 | $1.5M |
| Vision | HM LIFE INSURANCE COMPANY | 4,039 | $257K |
| Life insurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,784 | $1.2M |
| Long-term disability(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,784 | $1.4M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,784 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,383 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.