| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADMINISTRATIVE SOLUTIONS INC.3 Filed as: ADMINISTRATIVE SOLUTIONS, INC. | 555 W. SHAW AVE. SUITE C1 FRESNO, CA 937042503 | AMERITAS LIFE INSURANCE CORP. | — | $391 | $391 | — |
| DENNIS LEE INSURANCE SERVICES INC3 Filed as: DENNIS LEE INSURANCE SERVICES | 4688 W. JENNIFER SUITE 103 FRESNO, CA 93722 | HARTFORD LIFE & ACCIDENT | $56K | — | $56K | — |
| CORNERSTONE INS & FINANCIAL3 | 4851 LBJ FREEWAY STE 100 DALLAS, TX 75244 | HARTFORD LIFE & ACCIDENT | — | $22K | $22K | — |
| DENNIS LEE INSURANCE SERVICES INC3 Filed as: DENNIS O. LEE | 4688 W. JENNIFER AVE. SUITE 103 FRESNO, CA 93722 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | — |
| DENNIS LEE INSURANCE SERVICES INC3 Filed as: DENNIS LEE INSURANCE SERVICES, INC. | 4688 W. JENNIFER AVE. SUITE 103 FRESNO, CA 937226418 | VISION SERVICE PLAN | $6K | — | $6K | — |
| MORTENSON INSURANCE3 | 8500 STOCKDALE HWY SUITE 200 BAKERSFIELD, CA 93311 | HARTFORD LIFE AND ACCIDENT | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH I EIN 95-4331852 N/A | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30302 | $183K |
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 | 1,813 | 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) | 1,813 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | AMERITAS LIFE INSURANCE CORP. | 1,813 | $0 |
| Vision(2 contracts, 2 carriers) | HARTFORD LIFE & ACCIDENT | 1,017 | $0 |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE & ACCIDENT | 1,017 | $0 |
| Long-term disability | HARTFORD LIFE & ACCIDENT | 1,017 | $0 |
| Other(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,813 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,813 | — |
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.