| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE WASHINGTON, PA 19034 | BLUE CROSS OF CALIFORNIA | $75K | — | $75K | 3.91% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | — | $35K | $35K | 1.82% |
| TEMPLIN KACURA INSURANCE SERVICES3 Filed as: TEMPLIN KACURA | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $23K | $12K | $35K | 1.81% |
| WALTOS INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $3K | $13K | 16.51% |
| DANIEL TEMPLIN3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 8.00% |
| FMLASOURCE INC3 Filed as: FMLASOURCE INC. | 455 N CITYFRONT PLZ DR CHIGAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 6.29% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURACE | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.50% |
| WALTOS INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 16.04% |
| DANIEL TEMPLIN3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 8.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.68% |
| WALTOS INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 18.85% |
| DANIEL TEMPLIN3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 8.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.29% |
| WALTOS INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 17.46% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $507 | — | $507 | 2.28% |
| VOLUNTARY BENEFITS SPECIALISTS LLC3 Filed as: VOLUNTARY BENEFITS SPECIALISTS | 289 FARRIS AVENUE LAS VEGAS, NV 89183 | TRANSAMERICA LIFE INSURANCE COMPANY | $7K | — | $7K | 50.02% |
| WALTOS INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $528 | $2K | 16.20% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET, SUITE 570 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $358 | — | $358 | 2.53% |
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 | 287 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 291 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 287 | $1.9M |
| Dental | BLUE CROSS OF CALIFORNIA | 287 | $1.9M |
| Vision | BLUE CROSS OF CALIFORNIA | 287 | $1.9M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 287 | $2.0M |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 92 | $80K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $52K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 287 | $1.9M |
| Other(5 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 287 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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.