| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES INC. | DBA BXA INSURANCE SERVICES 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AETNA LIFE INSURANCE CO. | $39K | — | $39K | 2.33% |
| DAVID HARRIS ASBURY3 | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 30326 | AETNA LIFE INSURANCE CO. | $26K | — | $26K | 1.58% |
| PENBEN FINANCIAL SERVICES INC. DBA3 | BXA INSURANCE SERVICES 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AETNA HEALTH, INC. | $19K | — | $19K | 1.84% |
| DAVID HARRIS ASBURY3 | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 30326 | AETNA HEALTH, INC. | $16K | — | $16K | 1.58% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES INC. | DBA BXA INSRUANCE SERVICES 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AETNA | $4K | — | $4K | 4.41% |
| BENEFITS EXCHANGE ALLIANCE3 Filed as: BENEFITS EXCHANGE ALLIANCE INC. | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | PRUDENTIAL INSURANCE COMPANY | $2K | — | $2K | 6.21% |
| DAVID HARRIS ASBURY3 Filed as: DAVID ASBURY C | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 30326 | PRUDENTIAL INSURANCE COMPANY | $1K | — | $1K | 4.14% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA INC | LOCKBOX 100065 PO BOX 100065 PASADENA, CA 911890065 | PRUDENTIAL INSURANCE COMPANY | $178 | — | $178 | 0.67% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTHCHER DR LAKE FOREST, CA 926301771 | VISION SERVICE PLAN | $890 | — | $890 | 3.71% |
| DAVID ASBURY3 | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 303261555 | VISION SERVICE PLAN | $337 | — | $337 | 1.40% |
| BENEFITS EXCHANGE ALLIANCE5 Filed as: BENEFITS EXCHANGE ALLIANCE INC. | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 40.52% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH THOMAS CHRISTOPHER | 2928 FOSTER CREIGHTON DRIVE NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $590 | $5K | 22.99% |
| PROFESSIONAL PENSION INC.1 Filed as: PROFESSIONAL PENSION AND BENEFIT | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 8.66% |
| BENEFIT EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED CONCORDIA INSURANCE COMPANY | $932 | — | $932 | 8.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 100 ADDRESS NOT INCLUDED PASADENA, CA 91189 | UNITED CONCORDIA INSURANCE COMPANY | $185 | — | $185 | 1.74% |
| DAVID ASBURY3 | PHIPPS TOWER SUITE 1100 3438 PEACHTREE ROAD ATLANTA, GA 30326 | PRUDENTIAL INSURANCE COMPANY | $294 | — | $294 | 10.36% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 926301771 | VISION SERVICE PLAN | $57 | — | $57 | 3.41% |
| BENEFIT EXCHANGE ALLIANCE3 Filed as: BENEFIT EXCHANGE ALLIANCE INC. | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $79 | — | $79 | 8.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 801 S FIGUEROA STREE SUITE 700 LOS ANGELES, CA 90017 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $47 | — | $47 | 5.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIS OF MASSACHUSETTS, INC. THIRD PARTY ADMINISTRATO | Contract Administrator; Plan Administrator; Insurance brokerage commissions and fees Service code 13 | 3200 GUASTI ROAD 100 ONTARIO, CA 917610000 | $0 |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 713 | $1.8M |
| Dental(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 713 | $1.7M |
| Vision(2 contracts) | VISION SERVICE PLAN | 248 | $26K |
| Life insurance(3 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 713 | $1.7M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $16K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $16K |
| Other(4 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 713 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 713 | — |
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.