| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS SERVICE | $8K | $33K | $41K | 4.72% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS SERVICE | $2K | $10K | $12K | 1.32% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EPIC - EDGEWOOD PARTNERS INC. CTR. | PO BOX 102159 PASADENA, CA 91189 | AMERICAN FIDELITY ASSURANCE COMPANY | $5K | $0 | $5K | 4.95% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 2.83% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | MEDIEXCEL HEALTH PLAN | $1K | $0 | $1K | 4.00% |
| USI INSURANCE SERVICES LLC3 | 4370 LA JOLLA VILLAGE DRIVE SAN DIEGO, CA 92112 | MEDIEXCEL HEALTH PLAN | $1K | $0 | $1K | 3.14% |
| USI INSURANCE SERVICES LLC3 | 2800 WEST MARCH LANE, SUITE 100 STOCKTON, CA 95219 | PRINCIPAL LIFE INSURANCE COMPANY | $958 | $0 | $958 | 10.01% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $486 | $0 | $486 | 5.08% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 1390 WILLOW PASS ROAD, SUITE 800 CONCORD, CA 94520 | PRINCIPAL LIFE INSURANCE COMPANY | $201 | $0 | $201 | 2.10% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $303 | $0 | $303 | 8.90% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $38 | $0 | $38 | 1.12% |
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 | 203 | 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) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 166 | $912K |
| Dental | CALIFORNIA PHYSICIANS SERVICE | 166 | $877K |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 166 | $877K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 203 | $13K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 52 | $110K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 52 | $110K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 166 | $912K |
| Other(3 contracts, 3 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 203 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.