| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 1350 BAYSHORE HWY STE 218 BURLINGAME, CA 94010 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $63K | $1K | $64K | 4.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS OF CA INC | 3697 MT DIABLO BLVD SUITE 100 LAFAYETTE, CA 94549 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $27K | $27K | 1.76% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $13K | — | $13K | 0.82% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSET LOOP STE 304 MANASSAS, VA 20109 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $2K | $2K | 0.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $0 | $7K | $7K | 33.60% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLZ STE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $3K | — | $3K | 15.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | — | $5K | $5K | 25.65% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLZ STE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $3K | — | $3K | 15.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $0 | $6K | $6K | 35.18% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLZ STE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $2K | — | $2K | 15.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY(MUTUAL OF OMAHA) | $0 | $4K | $4K | 25.87% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLZ STE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY(MUTUAL OF OMAHA) | $2K | — | $2K | 15.00% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 3.22% |
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $1.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $1.5M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $1.5M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 129 | $30K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 32 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 129 | $19K |
| Prescription drug | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $1.5M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 129 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.