| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS | ATTN MARCUS VANNEMAN 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | CALIFORNIA CHOICE | $72K | — | $72K | 6.92% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS SERV | ATTN ORION RISK 245 S LOS ROBLES AVENUE SUITE 400 PASADENA, CA 91101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $131 | — | $131 | 0.67% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVIC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $65 | — | $65 | 0.33% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS SERV | ATTN ORION RISK 245 245 S LOS ROBLES AVENUE SUITE 400 PASADENA, CA 91101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $109 | — | $109 | 0.68% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVIC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $55 | — | $55 | 0.34% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS SERV | ATTN ORION RISK 245 S LOS ROBLES AVENUE SUITE 400 PASADENA, CA 91101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $46 | — | $46 | 0.67% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVIC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $23 | — | $23 | 0.34% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS SERV | ATTN ORION RISK 245 S LOS ROBLES AVENUE SUITE 400 PASADENA, CA 91101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $605 | — | $605 | 15.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC | PO BOX 948 HENRIETTA, NY 14467 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $27 | — | $27 | 0.67% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERV | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14 | — | $14 | 0.35% |
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA CHOICE | 126 | $1.0M |
| Dental | CALIFORNIA CHOICE | 126 | $1.0M |
| Vision | CALIFORNIA CHOICE | 126 | $1.0M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $16K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $7K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $19K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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.