| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 38402 CONSTELLATION ROAD VALENCIA, CA 91355 | ANTHEM BLUE CROSS | $86K | — | $86K | 2.50% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 28402 CONSTELLATION ROAD VALENCIA, CA 91355 | KAISER FOUNDATION HEALTH PLAN INC. | $31K | — | $31K | 2.55% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 28402 CONSTELLATION ROAD VALENCIA, CA 91355 | MUTUAL OF OMAHA INSURANCE COMPANY | $20K | — | $20K | 5.00% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 28402 CONSTELLATION ROAD VALENCIA, CA 91355 | DELTA DENTAL OF CALIFORNIA | $10K | — | $10K | 2.50% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS INC | 28402 COSTELLATION ROAD VALENCIA, CA 91355 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 7.27% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS INC | 38402 CONSTELLATION ROAD VALENCIA, CA 91355 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $926 | — | $926 | 1.67% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 28402 CONSTELLATION ROAD VALENCIA, CA 91355 | EXPRESS SCRIPTS, INC. | $1K | — | $1K | 3.57% |
| BENEFITS & RISK SOLUTIONS, INC.3 Filed as: BENEFITS & RISK SOLUTIONS | 28402 CONSTELLATION ROAD VALENCIA, CA 91355 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $687 | — | $687 | 5.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: REUBEN WARNER ASSOCIATES, INC | 1655 RICHMOND AVE STATEN ISLAND, NY 10314 | HARTFORD LIFE AND ACCIDENT | $289 | $13 | $302 | 17.76% |
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 | 674 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 685 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 313 | $4.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 437 | $394K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 353 | $56K |
| Life insurance | MUTUAL OF OMAHA INSURANCE COMPANY | 674 | $405K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 674 | $405K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 674 | $405K |
| Prescription drug(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 313 | $4.7M |
| Other(6 contracts, 6 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 674 | $583K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 674 | — |
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.