| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET NEWPORT BEACH, CA 92660 | AETNA LIFE INSURANCE COMPANY | $25K | — | $25K | 3.96% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1500 QUIAIL STREET NEWPORT BEACH, CA 92660 | AETNA HEALTH, INC. | $4K | — | $4K | 3.99% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 7777 CENTER AVENUE HUNTINGTON BEACH, CA 92647 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $2K | $9K | 11.73% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | 2677 N MAIN STREET SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 3.27% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 7777 CENTER AVENUE HUNTINGTON BEACH, CA 92647 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $2K | $3K | 25.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $241 | $241 | 2.11% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 7777 CENTER AVENUE HUNTINGTON BEACH, CA 92647 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $844 | $1K | $2K | 26.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $199 | $199 | 2.36% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 7777 CENTER AVENUE HUNTINGTON BEACH, CA 92647 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $288 | $491 | $779 | 27.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $74 | $74 | 2.57% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 7777 CENTER AVENUE HUNTINGTON BEACH, CA 92647 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $209 | $321 | $530 | 25.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $44 | $44 | 2.10% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 94 | $709K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 79 | $73K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 79 | $73K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $11K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 19 | $11K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 22 | $3K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 94 | $709K |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 105 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.