| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INS. | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS SERVICE | $66K | $0 | $66K | 5.00% |
| AMWINS3 Filed as: LISI, INC. | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS SERVICE | $46K | $0 | $46K | 3.48% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | GUARDIAN | $10K | $4K | $14K | 13.66% |
| FMLASOURCE INC3 Filed as: FMLASOURCE, INC | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 21.15% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 19000 MACARTHUR BOULEVARD PENTHOUSE SUITE IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $632 | $5K | 17.43% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INS. | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $653 | $0 | $653 | 10.00% |
| AMWINS3 Filed as: LISI, INC. | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $68 | $0 | $68 | 1.04% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 230 | $1.3M |
| Dental | GUARDIAN | 211 | $100K |
| Vision | GUARDIAN | 211 | $100K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 54 | $26K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 230 | $1.3M |
| Other(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 230 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.