| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE SERVICES | 2945 TOWNSGATE ROAD, SUITE 200 WESTLAKE VILLAGE, CA 91361 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $105K | $0 | $105K | 2.09% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $53K | $0 | $53K | 1.06% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY GROUP BENEFITS, LLC | 3615 OLD CONEJO ROAD NEWBURY PARK, CA 91320 | KAISER FOUNDATION HEALTH PLAN INC | $30K | $0 | $30K | 2.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $4K | $0 | $4K | 0.30% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE SERVICES | 2945 TOWNSGATE ROAD, SUITE 200 WESTLAKE VILLAGE, CA 91361 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | $0 | $8K | 2.47% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 1.42% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE SERVICES | 2945 TOWNSGATE ROAD, SUITE 200 WESTLAKE VILLAGE, CA 91361 | VISION SERVICE PLAN | $1K | $0 | $1K | 3.06% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $947 | $0 | $947 | 2.01% |
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 | 643 | 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) | 643 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 398 | $6.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 398 | $5.0M |
| Vision | VISION SERVICE PLAN | 393 | $47K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 496 | $324K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 496 | $324K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 496 | $324K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 398 | $6.5M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 643 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 643 | — |
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."
No prospect flags tripped on this filing.