| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 1357 A EAST LASSEN AVENUE CHICO, CA 95926 | UNUM LIFE INSURANCE COMPANY OF AMIERICA | $3K | $281 | $3K | 9.12% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 330 TRES PINOS ROAD, SUITE A1 HOLLISTER, CA 95023 | UNUM LIFE INSURANCE COMPANY OF AMIERICA | $1K | $180 | $2K | 4.98% |
| PLANSOURCE BENEFIT ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMINISTRATOR | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMIERICA | $196 | $0 | $196 | 0.62% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES LLC | PO BOX 2268 MERCED, CA 95344 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $487 | $0 | $487 | 11.08% |
| BEERE & PURVES INC3 | 500 YGNACIO VALLEY ROAD, SUITE 450 WALNUT CREEK, CA 94596 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $244 | $244 | 5.55% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 1357 A EAST LASSEN AVENUE CHICO, CA 95926 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 2.03% |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMIERICA | 102 | $36K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 4 | $1K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMIERICA | 102 | $32K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMIERICA | 102 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.