| 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 | $8K | — | $8K | 0.55% |
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 NEW YORK, NY 100878852 | DELTA DENTAL OF CALIFORNIA | $15K | — | $15K | 3.00% |
| SAMIR H. SHETH3 Filed as: SAMIR H SHETH | 2603 PALM AVE MANHATTAN BEACH, CA 90266 | HARTFORD LIFE AND ACCIDENT | $9K | — | $9K | 3.63% |
| RICHARD C. CALLISTER3 Filed as: RICHARD C CALLISTER | 4929 HILLARD AVE LA CANADA, CA 91011 | HARTFORD LIFE AND ACCIDENT | $9K | — | $9K | 3.63% |
| BRET M BOEGER3 | 4551 W. 107TH STREET SUITE 310 OVERLAND PARK, KS 66207 | HARTFORD LIFE AND ACCIDENT | $5K | — | $5K | 1.81% |
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | RELIASTAR LIFE INSURANCE COMPANY | $5K | — | $5K | 6.00% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 5600 W 83RD ST 8200 TOWER, STE 1100 BLOOMINGTON, MN 55437 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 14.93% |
| WILLIS TOWERS WATSON US LLC4 | PO BOX 28852 NEW YORK, NY 100878852 | DELTA DENTAL OF CALIFORNIA | $614 | — | $614 | 3.00% |
| SAMIR H. SHETH3 Filed as: SAMIR HARSHAD SHETH | 2603 PALM AVE MANHATTAN BEACH, CA 90266 | HARTFORD LIFE AND ACCIDENT | $540 | — | $540 | 4.00% |
| RICHARD C. CALLISTER3 | 4929 HILLARD AVE LA CANADA, CA 91011 | HARTFORD LIFE AND ACCIDENT | $540 | — | $540 | 4.00% |
| BRET M BOEGER3 | 4551 W 107TH STREET STE 310 OVERLAND PARK, KS 66207 | HARTFORD LIFE AND ACCIDENT | $270 | — | $270 | 2.00% |
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 | 645 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 655 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | ANTHEM BLUE CROSS | 197 | $3.5M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 872 | $534K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 836 | $76K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 609 | $252K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 609 | $252K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 609 | $252K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 111 | $80K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 609 | $307K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 872 | — |
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.