| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC6 | PO BOX 85638 SAN DIEGO, CA 92186 | KAISER FOUNDATION HEALTH PLAN INC | — | $181 | $181 | 0.04% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: BARNEY & BARNEY | PO BOX 85638 SAN DIEGO, CA 92186 | MET LIFE | — | $38 | $38 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| POLYCOMP ADMINISTRATIVE SERVICES EIN 95-2889854 PLAN ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 404 CAMINO DEL RIO SOUTH, SUITE 608 SAN DIEGO, CA 92108 | $95K |
| WOLDS LAW GROUP EIN 80-0462356 N/A | Direct payment from the plan; Legal Service code 29 | 4747 EXECUTIVE DRIVE SAN DIEGO, CA 92121 | $61K |
| WESTCOAST GROUP BENEFITS N/A | Direct payment from the plan; Other commissions Service code 50 | 10809 THORNMINT ROAD, SUITE A SAN DIEGO, CA 92127 | $47K |
| BARNEY & BARNEY N/A | Direct payment from the plan; Other commissions Service code 50 | 9171 TOWNE CENTRE DRIVE, SUITE 500 SAN DIEGO, CA 92122 | $41K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | 4747 EXECUTIVE DRIVE, SUITE 1300 SAN DIEGO, CA 92121 | $32K |
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 | 839 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 843 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTH CARE | 81 | $1.1M |
| Dental | MET LIFE | 690 | $278K |
| Vision | UHC | 162 | $18K |
| Life insurance | UHC LIFE | 216 | $11K |
| Other | OPTUM HEALTH - CHIRO | 178 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 690 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.