| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | 225 KENNETH DR ROCHESTER, NY 14623 | CALIFORNIACHOICE | $29K | — | $29K | 2.91% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | RYAN PRESTON 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | CALIFORNIACHOICE | $17K | — | $17K | 1.69% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | MARIO GOSALVEZ 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | CALIFORNIACHOICE | $4K | — | $4K | 0.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFIS | AN ALERA GROUP AGENCY 333 N GLENOAKS BLVD STE 410 BURBANK, CA 91502 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 5.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 225 KENNETH DR ROCHESTER, NY 14623 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 4.97% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 4.38% |
| JOSE ANTONIO PEREZ3 | 224 AIRPORT PKWY STE 620 SAN JOSE, CA 95110 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 1.08% |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 99 | $1.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $114K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $114K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $114K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $114K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $114K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.