| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SANDS CHEVROLET LLC3 | 16991 W WADDEL RD SURPRISE, AZ 85388 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 12.60% |
| LEOBARDO J PINEDA3 Filed as: LEOBARDO JOHN PINEDA | PO BOX 67995 PHOENIX, AZ 85082 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $529 | $0 | $529 | 5.44% |
| RENE ADRIAN RODRIGUEZ3 Filed as: RENE A RODRIGUEZ | 914 N 73RD PLACE SCOTTSDALE, AZ 85257 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $404 | $0 | $404 | 4.15% |
| SHARON MCKELVEY3 | 197 NOTTINGHAM LANE LOT 3 PAYSON, AZ 85541 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $92 | $0 | $92 | 0.95% |
| REBECCA J MERRITT3 | 927 EAST KEIM DRIVE PHOENIX, AZ 85014 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $64 | $0 | $64 | 0.66% |
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 | 348 | 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) | 348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 341 | $135K |
| Dental | METLIFE | 248 | $6K |
| Life insurance(3 contracts, 3 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 200 | $13K |
| Short-term disability | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 197 | $10K |
| Other(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 200 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.