| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | CALIFORNIA PHYSICIANS SERVICE | $32K | — | $32K | 5.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | UNION SECURITY INSURANCE COMPANY | $4K | — | $4K | 10.13% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | ANTHEM LIFE INSURANCE COMPANY | $4K | — | $4K | 26.98% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FINANCIAL SVCS | 6200 CANOGA AVENUE, SUITE 300 WOODLAND HILLS, CA 91367 | ANTHEM LIFE INSURANCE COMPANY | — | $890 | $890 | 6.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD, SUITE 100 PASADENA, CA 91107 | ANTHEM LIFE INSURANCE COMPANY | — | $70 | $70 | 0.50% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | EYEMED VISION CARE | $904 | — | $904 | 9.44% |
| JOHNSON RESOURCES3 | 7373 DOUBLETREE RANCH, SUITE 200 SCOTTSDALE, AZ 85858 | EYEMED VISION CARE | — | $181 | $181 | 1.89% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | UDC DENTAL OF CALIFORNIA, INC. | $451 | — | $451 | 10.11% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 26.98% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FINANCIAL SVCS | 6200 CANOGA AVENUE, SUITE 300 WOODLAND HILLS, CA 91367 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $278 | $278 | 6.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD, SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $22 | $22 | 0.51% |
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 | 180 | 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) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 110 | $689K |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 71 | $47K |
| Vision | EYEMED VISION CARE | 118 | $10K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 168 | $4K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 198 | $14K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 110 | $689K |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 168 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.