| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | CALIFORNIA PHYSICIANS SERVICE | $32K | — | $32K | 3.68% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE WASHINGTON, PA 19034 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 4.89% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | 2677 N MAIN STREET SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 1.67% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $3K | $11K | 10.34% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | 2677 N MAIN STREET SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $2K | $5K | 4.82% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 19.51% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $847 | $811 | $2K | 19.57% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $434 | $417 | $851 | 19.63% |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 76 | $1.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 97 | $103K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 97 | $103K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $15K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 76 | $1.1M |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 112 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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.