| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | ANTHEM BLUE CROSS | $7K | — | $7K | 0.65% |
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 NEW YORK, NY 100878852 | DELTA DENTAL OF CALIFORNIA | $15K | — | $15K | 3.13% |
| SAMIR H. SHETH3 Filed as: SAMIR H SHETH | 515 S FLOWER ST 18TH FL LOS ANGELES, CA 90071 | HARTFORD LIFE AND ACCIDENT | $11K | — | $11K | 4.00% |
| RICHARD C. CALLISTER3 Filed as: RICHARD C CALLISTER | 4929 HILLARD AVE LA CANADA, CA 91011 | HARTFORD LIFE AND ACCIDENT | $11K | — | $11K | 4.00% |
| BRET M BOEGER3 | 4551 W. 107TH STREET SUITE 310 OVERLAND PARK, KS 66207 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 2.00% |
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 NEW YORK, NY 100878852 | DELTA DENTAL OF CALIFORNIA | $519 | — | $519 | 3.14% |
| SAMIR H. SHETH3 Filed as: SAMIR HARSHAD SHETH | 2603 PALM AVE MANHATTAN BEACH, CA 90266 | HARTFORD LIFE AND ACCIDENT | $381 | — | $381 | 4.00% |
| RICHARD C. CALLISTER3 | 4929 HILLARD AVE LA CANADA, CA 91011 | HARTFORD LIFE AND ACCIDENT | $381 | — | $381 | 4.00% |
| BRET M BOEGER3 | 4551 W 107TH STREET STE 310 OVERLAND PARK, KS 66207 | HARTFORD LIFE AND ACCIDENT | $190 | — | $190 | 1.99% |
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 | 584 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 588 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | ANTHEM BLUE CROSS | 193 | $3.4M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 800 | $480K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 757 | $72K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 569 | $280K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 569 | $280K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 569 | $280K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE AND HEALTH INSURANCE CO. | 586 | $77K |
| Other(2 contracts) | HARTFORD LIFE AND ACCIDENT | 569 | $290K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 800 | — |
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."
No prospect flags tripped on this filing.