| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AETNA LIFE INSURANCE COMPANY | $28K | $12K | $40K | 3.97% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AETNA HEALTH, INC. | $22K | — | $22K | 3.00% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | — | $12K | 1.81% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | GROUP HEALTH COOPERATIVE | $877 | — | $877 | 2.17% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $701 | $740 | $1K | 4.11% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $574 | $458 | $1K | 3.60% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $539 | — | $539 | 1.92% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | VISION SERVICE PLAN | $1K | — | $1K | 5.24% |
| PENSION & BENEFIT INSURANCE SERVICE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $224 | $262 | $486 | 4.35% |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 353 | $2.5M |
| Dental | AETNA LIFE INSURANCE COMPANY | 353 | $1.0M |
| Vision | VISION SERVICE PLAN | 131 | $23K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $46K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $29K |
| Prescription drug(5 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 353 | $2.5M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 353 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.