Form 5500 · Employee benefit plan · ONTARIO, CA
ATLANTIC SOLUTIONS GROUP, INC. DBA EMPIRE WORKFORCE SOLUTIONS
The filing calls this plan EMPIRE STAFFING SOLUTIONS HEALTH & WELFARE BENEFITS PLAN.
Public Form 5500 records show how ATLANTIC SOLUTIONS GROUP, INC. DBA EMPIRE WORKFORCE SOLUTIONS of ONTARIO, CA, a administrative and support services employer, structures its employee benefits. Its broker of record is DAVID B. ADAMS III. Coverage is written through ANTHEM BLUE CROSS and 2 other carriers. The plan's most recent policy period ended in April.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-2442208 · plan 501 · plan year 2024, filed Feb 13, 2025
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213 other employer plans in California have policy years ending in April. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Dental: UNITED OF OMAHA LIFE INSURANCE COMPANY covers 42 of 1,552 participants (2.7%) on Schedule A.
Vision: VISION SERVICE PLAN covers 42 of 1,552 participants (2.7%) on Schedule A.
Life: UNITED OF OMAHA LIFE INSURANCE COMPANY covers 42 of 1,552 participants (2.7%) on Schedule A.
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision and life; the largest, with ANTHEM BLUE CROSS, covers 1,625 people.
Reported premium across the insured contracts is $551,740, with $26,995 in disclosed broker commissions — about 4.9% of premium.
The most recent policy period ended in April, and the plan year ends April 30. Group contracts typically renew on that annual cycle.
DAVID B. ADAMS III is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including ANTHEM BLUE CROSS, UNITED OF OMAHA LIFE INSURANCE COMPANY and VISION SERVICE PLAN. ANTHEM BLUE CROSS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS | Health | 1,625 | May 1, 2024 | $503,202 | $21,241 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Dental, Life | 42 | May 1, 2024 | $41,543 | $4,630 |
| VISION SERVICE PLAN | Vision | 42 | May 1, 2024 | $6,995 | $1,124 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 3,850 employees, 69 recordable cases, 762 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
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Renewal calendar
213 other employer plans in California are May 1 renewals (policy year ends April).
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