| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT PRO INSURANCE SERVICES, INC3 | 2655 CAMINO DEL RIO NORTH SUITE 370 SAN DIEGO, CA 92108 | BLUE CROSS OF CALIFORNIA | $29K | $0 | $29K | 2.79% |
| ROBERT HOTALING3 | 8 FLETCHER PLACE MELVILLE, NY 11747 | BLUE CROSS OF CALIFORNIA | $9K | $0 | $9K | 0.88% |
| BENEFIT PRO INSURANCE SERVICES, INC3 | 2655 CAMINO DEL RIO NORTH SUITE 370 SAN DIEGO, CA 92108 | KAISER FOUNDATION HEALTH PLAN, INC. | $9K | $0 | $9K | 2.80% |
| ROBERT HOTALING3 | 125 PARK AVENUE NEW YORK, NY 10017 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | $0 | $5K | 1.41% |
| BENEFIT PRO INSURANCE SERVICES, INC3 | 2655 CAMINO DEL RIO NORTH SUITE 370 SAN DIEGO, CA 92108 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | $0 | $10K | 6.73% |
| ROBERT HOTALING3 Filed as: ROBERT MARTIN HOTALING | 8 FLETCHER PLACE MELVILLE, NY 11747 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.74% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERRPISE DRIVE, SUITE 204 SHELTON, CT 06484 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.05% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 118 | $1.4M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 191 | $152K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 191 | $152K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 191 | $152K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 191 | $152K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 191 | $152K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 118 | $1.4M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 191 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.