| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, LLC | 311 CAMINO DEL RIO N STE 110 SAN DIEGO, CA 92108 | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | — | $37K | $37K | 4.69% |
| WELDON G KERR3 | RBG SAN JOSE 6155 ALMADEN EXPWY #210 SAN JOSE, CA 95120 | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | — | $15K | $15K | 1.87% |
| JENNY LYNN VONDERWERTH3 | 585 BLAIRBURRY WAY SAN JOSE, CA 95123 | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | — | $62 | $62 | 0.01% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGRIFF, A MARSH & MCLENNAN AGENCY | 7701 AIRPORT CENTER DRIVE SUITE 1800 GREENSBORO, NC 27409 | STARMOUNT LIFE INSURANCE COMPANY | $6K | $410 | $6K | 13.42% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W VEVA 16 SUITE 320 BLUE BELL, PA 19422 | STARMOUNT LIFE INSURANCE COMPANY | — | $3K | $3K | 6.13% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGRIFF, A MARSH & MCLENNAN AGENCY | 7701 AIRPORT CENTER DRIVE SUITE 1800 GREENSBORO, NC 27409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $126 | $2K | 10.75% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W VEVA 16 SUITE 320 BLUE BELL, PA 19422 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $839 | $839 | 5.00% |
| MCGRIFF INSURANCE SERVICES INC3 | 7701 AIRPORT CENTER DR GREENSBORO, NC 27409 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $363 | — | $363 | 3.32% |
| BRITTANY LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $212 | $113 | $325 | 2.97% |
| BRIAN ROBERT LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $73 | $150 | $223 | 2.04% |
| CASEY JAMES KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $162 | $203 | 1.86% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $150 | $50 | $200 | 1.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | — | $152 | 1.39% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $21 | $122 | 1.12% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.18% |
| PAMELA KAY LONG3 | 200 S LEXINGTON DR APT 615 FOLSOM, CA 95630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | 152 | $795K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 100 | $45K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 100 | $45K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $17K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $17K |
| Prescription drug | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | 152 | $795K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.