| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | CALIFORNIA PHYSICIANS SERVICE | $0 | $5K | $5K | 0.12% |
| USI INSURANCE SERVICES LLC3 | 630 WEST GERMANTOWN PIKE, SUITE 20 PLYMOUTH MEETING, PA 19462 | CALIFORNIA PHYSICIANS SERVICE | $0 | $125 | $125 | 0.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 2185 NORTH CALIFORNIA BOULEVARD SUITE 400 WALNUT CREEK, CA 94596 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | -$19 | $0 | -$19 | -0.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | $0 | $2K | 0.51% |
| ALLIANT INSURANCE SERVICES, INC.3 | 2185 NORTH CALIFORNIA BOULEVARD SUITE 400 WALNUT CREEK, CA 94596 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $2K | $9K | 6.24% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $3K | $0 | $3K | 5.42% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | VISION SERVICE PLAN | $2K | $0 | $2K | 2.97% |
| ANTHEM INSURANCE COMPANIES, INC.3 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 46204 | FOUR EVER LIFE INSURANCE COMPANY | $0 | $55 | $55 | 1.01% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 440 | $4.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 187 | $387K |
| Vision | VISION SERVICE PLAN | 189 | $56K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 187 | $148K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 187 | $148K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 187 | $148K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 440 | $4.6M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 187 | $153K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 440 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.