| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | UNITED HEALTHCARE INSURNACE COMPANY | $45K | $0 | $45K | 4.45% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC | 2301 ROSECRANCS AVE STE 4130 EL SEGUNDO, CA 90245 | UNITED HEALTHCARE INSURNACE COMPANY | $4K | $0 | $4K | 0.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC (CA) | 2030 MAIN STREET, SUITE 700 IRVINE, CA 926147253 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $11K | $0 | $11K | 8.22% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SER WFIS-SHERMANOAK | DEPT 33720 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 8.12% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $220 | $0 | $220 | 0.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC (CA) | 2030 MAIN STREET, SUITE 200 IRVINE, CA 92614 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $1K | $0 | $1K | 8.14% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SERVIC | NCB-88 MINNEAPOLIS, MN 554801414 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $127 | $0 | $127 | 0.82% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | WFIS-SHERMAN OAK - DEPT 33720 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 9.08% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $125 | $0 | $125 | 0.92% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | WFIS-SHERMAN OAK - DEPT 33720 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $315 | $0 | $315 | 9.08% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $31 | $0 | $31 | 0.89% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | WFIS-SHERMAN OAK - DEPT 33720 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $213 | $0 | $213 | 9.11% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $21 | $0 | $21 | 0.90% |
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 | 136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURNACE COMPANY | 238 | $1.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $128K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 213 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 181 | $23K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 25 | $2K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 32 | $14K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 181 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 238 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.