| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LISA A PERRI3 Filed as: LISA M CAMPAGNA | — | CALIFORNIA CHOICE | $10K | — | $10K | 1.74% |
| ENROLLEASE3 Filed as: GOLDEN STATE INSURANCE SO | — | CALIFORNIA CHOICE | $7K | — | $7K | 1.30% |
| FILICE INSURANCE AGENCY3 | — | CALIFORNIA CHOICE | $5K | — | $5K | 0.96% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | — | CALIFORNIA CHOICE | $3K | — | $3K | 0.47% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN MCGRAW | — | CALIFORNIA CHOICE | $2K | — | $2K | 0.45% |
| LISA CAMPAGNA3 | 11 CALYPSO SHORES NOVATO, CA 94949 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $5K | — | $5K | 6.87% |
| BEERE & PURVES INC3 Filed as: BEERE & PURVES, INC | 1350 TREAT BLVD, #470 WALNUT CREEK, CA 94597 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $4K | $4K | 4.73% |
| JON MCGRAW3 | 14 GALLI DR, SUITE 100A NOVATO, CA 94949 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $967 | — | $967 | 1.22% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | 7200 REDWOOD BLVD, #400 NOVATO, CA 94945 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $734 | — | $734 | 0.93% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 3736 MT DIABLO BLVD, SUITE 301 LAFAYETTE, CA 94549 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $729 | — | $729 | 0.92% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $800 | — | $800 | 4.79% |
| LISA MARIE CAMPAGNA3 | 58 CRESTWOOD DRIVE SAN RAFAEL, CA 94901 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $632 | — | $632 | 3.79% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $501 | — | $501 | 3.00% |
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 | 215 | 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) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA CHOICE | 113 | $558K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 151 | $79K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 151 | $79K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 181 | $17K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 181 | $17K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 181 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.