| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS LLC | 1122 S MAIN STREET GREENVILLE, SC 29601 | BLUE CROSS OF CALIFORNIA | $49K | $0 | $49K | 4.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS AN ALER | 333 N GLENOAKS BLVD STE 410 BURBANK, CA 91502 | BLUE CROSS OF CALIFORNIA | $0 | $23K | $23K | 2.14% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, LLC | 1122 S MAIN ST STE B GREENVILLE, SC 296013339 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 2.44% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 1122 S MAIN ST STE B GREENVILLE, SC 296013339 | KAISER FOUNDATION HEALTH PLAN INC | $326 | $0 | $326 | 0.34% |
| CAPITAL CITY BENEFITS3 Filed as: CAPITAL CITY BENEFITS & INSURANCE S | 400 SUNRISE AVE STE 250 ROSEVILLE, CA 956614106 | KAISER FOUNDATION HEALTH PLAN INC | $161 | $0 | $161 | 0.17% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, LLC | 1122 S MAIN ST STE B GREENVILLE, SC 296013339 | AMERITAS LIFE INSURANCE CORP | $9K | $0 | $9K | 10.00% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 3 PARKWAY NORTH BLVD STE 500 DEERFIELD, IL 600152567 | AMERITAS LIFE INSURANCE CORP | $0 | $2K | $2K | 2.59% |
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 | 176 | 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) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 80 | $1.2M |
| Dental | AMERITAS LIFE INSURANCE CORP | 387 | $87K |
| Vision | AMERITAS LIFE INSURANCE CORP | 387 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.