| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 | ONE PARK PLAZA, SUITE 600 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $130K | $3K | $133K | 4.12% |
| INSURANCE OFFICE OF AMERICA3 | ONE PARK PLAZA, SUITE 600 IRVINE, CA 92614 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $11K | $243 | $11K | 4.12% |
| INSURANCE OFFICE OF AMERICA3 | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 15.46% |
| DIANA LEWIS3 | 28059 US HIGHWAY 19 N, STE. 201 CLEARWATER, FL 33761 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $1K | $9K | 34.56% |
| INSURANCE OFFICE OF AMERICA3 | 1855 W. STATE ROAD 434 LONGWOOD, FL 32750 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $587 | $4K | 17.46% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $466 | $3K | 13.15% |
| DESSO FORMAN3 | 28059 US HIGHWAY 19 N, STE. 201 CLEARWATER, FL 33761 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 4.95% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY. SE, SUITE 600 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 16.67% |
| INSURANCE OFFICE OF AMERICA3 | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 15.92% |
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 | 337 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 338 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 321 | $3.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 337 | $278K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 337 | $278K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 337 | $309K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 26 | $22K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 47 | $20K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 321 | $3.2M |
| Other(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 337 | $334K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 337 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.