| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EVERETT INSURANCE AGENCY, INC. Filed as: EVERETT INSURANCE AGENCY INC | 1913 EAST 17TH ST #214 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $14K | $0 | $14K | 4.03% |
| GIBSON INSURANCE AGENCY, INC. Filed as: GIBSON INSURANCE AGENCY | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | GUARDIAN LIFE INSURANCE COMPANY | $20K | — | $20K | 7.43% |
| MJ INSURANCE Filed as: MJ | 571 MONON BLVD, SUITE 400 CARMEL, IN 46032 | GUARDIAN LIFE INSURANCE COMPANY | $4K | — | $4K | 1.34% |
| EVERETT INSURANCE AGENCY, INC. Filed as: EVERETT INSURANCE AGENCY INC | 1913 EAST 17TH ST #214 SANTA ANA, CA 92705 | CALIFORNIACHOICE | $11K | — | $11K | 6.66% |
| GIBSON INSURANCE AGENCY, INC. | 333 E JEFFERSON SR PLYMOUTH, IN 46563 | HEALTH ALLIANCE PLAN | $2K | — | $2K | 1.52% |
| MJ INSURANCE Filed as: MJ | 571 MONON BLVD, SUITE 400 CARMEL, IN 46032 | HEALTH ALLIANCE PLAN | $93 | — | $93 | 0.09% |
| MJ INSURANCE Filed as: MJ | 571 MONON BLVD, SUITE 400 CARMEL, IN 46032 | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | — |
| GIBSON INSURANCE AGENCY, INC. Filed as: GIBSON INSURANCE AGENCY, INC | P O BOX 11177 SOUTH BEND, IN 46634 | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $170K |
| MJ INSURANCE EIN 35-1109367 BROKER | Other commissions Service code 55 | — | $9K |
| GIBSON INSURANCE AGENCY EIN 35-1116724 BROKER | Other commissions Service code 55 | — | $5K |
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 | 371 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 371 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 101 | $526K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 543 | $274K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY | 543 | $274K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 543 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.