| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 29122 RANCHO VIEJO ROAD, SUITE 106 SAN JUAN CAPISTRANO, CA 92675 | HARTFORD LIFE AND ACCIDENT | $25K | — | $25K | 15.26% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 29122 RANCHO VIEJO ROAD, SUITE 106 SAN JUAN CAPISTRANO, CA 92675 | HM LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 29122 RANCHO VIEJO ROAD, SUITE 106 SAN JUAN CAPISTRANO, CA 92675 | ACE AMERICAN INSURANCE COMPANY | $182 | — | $182 | 19.98% |
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 | 509 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 556 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,065 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSM, INC. D.B.A.BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 440 | $618K |
| Vision | HM LIFE INSURANCE COMPANY | 294 | $32K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 509 | $161K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 509 | $161K |
| Prescription drug | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 437 | $546K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 509 | $170K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 509 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.