| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRACY LYNN JARVIS3 | 5784 PARKE CIRCLE RANCHO CUCAMONGA, CA 91739 | KAISER FOUNDATION HEALTH PLAN INC. | $30K | — | $30K | 3.62% |
| INSURANCE OFFICE OF AMERICA3 | 1855 W. STATE ROAD 434 LONGWOOD, FL 32750 | KAISER FOUNDATION HEALTH PLAN INC. | -$38 | — | -$38 | -0.00% |
| TRACY L. JARVIS3 | 5784 PARKE CIRCLE RANCHO CUCAMONGA, CA 91739 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 9.81% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | — | $5K | 44.17% |
| TRACY LYNN JARVIS3 | 5784 PARKE CIRCLE RANCHO CUCAMONGA, CA 91739 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 46.47% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 45.81% |
| DEREK RICHARD BREWART3 | 1282 W. ARROW HWY. UPLAND, CA 91786 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 1.76% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $307 | — | $307 | 44.69% |
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 | 178 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 202 | $836K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 103 | $94K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 103 | $94K |
| Life insurance(5 contracts, 2 carriers) | AFLAC | 90 | $29K |
| Short-term disability(4 contracts) | AFLAC | 90 | $22K |
| Other(5 contracts, 2 carriers) | AFLAC | 90 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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.