| 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 | — | $50K | $50K | 5.26% |
| 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 | — | $20K | $20K | 2.08% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES | PO BOX 896620 CHARLOTTE, NC 28289 | STARMOUNT LIFE INSURANCE COMPANY | $10K | $705 | $10K | 10.95% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PARKWAY W VEVA 16 BLUE BELL, PA 19422 | STARMOUNT LIFE INSURANCE COMPANY | — | $5K | $5K | 5.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES | PO BOX 896620 CHARLOTTE, NC 28289 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $165 | $2K | 10.75% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PARKWAY W VEVA 16 BLUE BELL, PA 19422 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $404 | — | $404 | 2.17% |
| BRITTANY LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $357 | $36 | $393 | 2.11% |
| MCGRIFF INSURANCE SERVICES INC3 | 7701 AIRPORT CENTER DR GREENSBORO, NC 27409 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $272 | — | $272 | 1.46% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $174 | $18 | $192 | 1.03% |
| BRIAN ROBERT LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $107 | $74 | $181 | 0.97% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | $43 | $141 | 0.76% |
| CASEY JAMES KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $34 | $121 | 0.65% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 0.28% |
| MICHAEL JAMES LEBRANE3 | 808 E 5TH AVE APT A SAN MATEO, CA 94402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.12% |
| PAMELA KAY LONG3 | 200 S LEXINGTON DR APT 615 FOLSOM, CA 95630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108 | 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 | $949K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 104 | $94K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 104 | $94K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $22K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $22K |
| Prescription drug | CALIFORNIA PHYSICIAN'S SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA | 152 | $949K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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.