| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | OPTIMA HEALTH PLAN | $28K | — | $28K | 3.03% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, SUITE 600 SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $18K | — | $18K | 3.97% |
| MJ INSURANCE3 Filed as: JACK HOLDER AND VARIOUS AGENTS | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $37K | $2K | $39K | 9.61% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92122 | AFLAC | $18K | — | $18K | 4.44% |
| JACQUELYN E. K. HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $8K | $662 | $9K | 2.26% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES, INC. | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $5K | $75 | $5K | 1.25% |
| VALERIE S. LEWIS3 | 6127 SOUTH RAINBOW BOULEVARD SUITE 110 LAS VEGAS, NV 89118 | AFLAC | $5K | $242 | $5K | 1.23% |
| HEATHER SIEMS3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $5K | $202 | $5K | 1.20% |
| RANDALL V. SHEKALUS3 | 666 ORANGEWOOD DRIVE VIRGINIA BEACH, VA 23453 | AFLAC | $4K | $235 | $4K | 0.98% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $22K | — | $22K | 7.86% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | VISION SERVICE PLAN | $2K | — | $2K | 2.68% |
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 | 768 | 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) | 768 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 639 | $6.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 768 | $453K |
| Vision | VISION SERVICE PLAN | 768 | $93K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 768 | $277K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 768 | $682K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 768 | $277K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 639 | $6.1M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 768 | $6.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 768 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.