| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $77K | — | $77K | 3.61% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | KAISER FOUNDATION HEALTH PLAN INC. | $19K | — | $19K | 5.12% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | KAISER FOUNDATION HEALTH PLAN INC. | $15K | — | $15K | 4.94% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| TIPPETT MOORHEAD AND HADEN3 Filed as: TIPPETT MOORHEAD & HADEN | 3200 PARK CENTER DR, STE 550 COSTA MESA, CA 92626 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 7.47% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST, STE 900 PORTLAND, OH 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $432 | $432 | 2.01% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| MODERN REIGN INSURANCE BROKERS3 Filed as: MODERN REIGN INSURANCE BROKERS, LLC | 27201 PUERTA REAL, SUITE 130 MISSION VIEJO, CA 92691 | EYEMED VISION CARE | $1K | — | $1K | 8.18% |
| TIPPETT MOORHEAD AND HADEN3 Filed as: TIPPETT MOORHEAD & HADEN | 3200 PARK CENTER DR, STE 550 COSTA MESA, CA 92626 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $262 | — | $262 | 6.13% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST, STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $107 | $107 | 2.50% |
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 | 233 | 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) | 233 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 185 | $2.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 185 | $2.1M |
| Vision | EYEMED VISION CARE | 317 | $16K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 233 | $47K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 64 | $19K |
| Long-term disability(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 233 | $93K |
| Prescription drug(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 185 | $2.8M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 233 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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."
No prospect flags tripped on this filing.