| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENBEN FINANCIAL SERVICES INC. DBA3 | BXA INSURANCE SERVICES 3744 MT DIABLO BLVD SUITE 205 LAYFAYETTE, CA 94549 | AETNA LIFE INSURANCE CO. | $18K | — | $18K | 1.08% |
| PENBEN FINANCIAL SERVICES INC. DBA3 | BXA INSURANCE SERVICES 23716 BIRTCHER DR LAKE FOREST, CA 92630 | AETNA LIFE INSURANCE CO. | $4K | — | $4K | 0.24% |
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 | 4 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 4 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 0 | $1.7M |
| Dental | AETNA LIFE INSURANCE CO. | 0 | $1.7M |
| Vision | AETNA LIFE INSURANCE CO. | 0 | $1.7M |
| Life insurance | AETNA LIFE INSURANCE CO. | 0 | $1.7M |
| Other | AETNA LIFE INSURANCE CO. | 0 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.