| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCHEIBNER, JEFFREY L3 | 28562 OSO PKWY D526 RANCHO STA MARG, CA 92688 | CALIFORNIA PHYSICIANS' SERVICE | $26K | — | $26K | 2.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVE., SW GRAND RAPIDS, MI 49503 | CALIFORNIA PHYSICIANS' SERVICE | $17K | — | $17K | 1.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | AN ALERA GROUP AGENCY, LLC 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | CALIFORNIA PHYSICIANS' SERVICE | — | $8K | $8K | 0.97% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INS 1120 BRISTOL ST COSTA MESA, CA 92626 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 8.51% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA BENEFITS DONE RIGHT 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | — | $5K | $5K | 6.31% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING LLC DBA SUVAUN | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.51% |
| SCHEIBNER, JEFFREY L3 | 28562 OSO PKWY D526 RANCHO STA MARG, CA 92688 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $55 | — | $55 | 9.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | AN ALERA GROUP AGENCY, LLC 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | — | $6 | $6 | 1.08% |
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 | 130 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 173 | $878K |
| Dental(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 201 | $964K |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 201 | $964K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $87K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 173 | $878K |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 90 | $554 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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.