| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENERGI3 Filed as: ENERGI FOR BUSINESS | 33302 VALLE ROAD, #250 SAN JUAN CAPISTRANO, CA 92675 | SHARP HEALTH PLAN | $23K | — | $23K | 5.00% |
| ENERGI3 Filed as: ENERGI FOR BUSINESS INS SERVICES | 33302 VALLE ROAD, 250 SAN JUAN CAPISTRANO, CA 92675 | KAISER PERMANENTE | $17K | — | $17K | 3.99% |
| EMPLOYERS NATIONAL EXPERT RESOURCE3 | 33302 VALLE ROAD, #250 SAN JUAN CAPISTRANO, CA 92675 | UNION SECURITY INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| EMPLOYERS NATIONAL EXPERT RESOURCE3 | 33302 VALLE ROAD, #250 SAN JUAN CAPISTRANO, CA 92675 | UDC DENTAL OF CALIFORNIA, INC. | $704 | — | $704 | 10.00% |
| ENERGI3 | 33302 VALLE ROAD, #250 SAN JUAN CAPISTRANO, CA 92675 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $451 | — | $451 | 9.63% |
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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SHARP HEALTH PLAN | 75 | $887K |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 52 | $52K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 66 | $5K |
| Prescription drug | SHARP HEALTH PLAN | 75 | $463K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 75 | — |
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.