| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD BROWN | 7560 CAMINO NORTE RANCHO CUCAMONGA, CA 917301025 | KAISER FOUNDATION HEALTH PLAN INC | $10K | — | $10K | 1.96% |
| PALO VERDE INC3 Filed as: PALO VERDE, INC. | 8546 CALLE CARABE ST RANCHO CUCAMONGA, CA 917301909 | KAISER FOUNDATION HEALTH PLAN INC | $10K | — | $10K | 1.96% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN INSURANCE | ADMINISTRATORS INC 721 S PARKER ST STE 200 ORANGE, CA 928684772 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 0.95% |
| JAMES ALAN DILKS3 Filed as: JAMES DILKS | 8546 CALLE CARABE ST RCH CUCAMONGA, CA 917301909 | KAISER FOUNDATION HEALTH PLAN INC | $43 | — | $43 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD LEE BROWN | 7560 CAMINO NORTE RANCHO CUCAMOGA, CA 91730 | AETNA LIFE INSURANCE CO. | $1K | — | $1K | 2.07% |
| PALO VERDE INC3 Filed as: PALO VERDE INC. | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 91730 | AETNA LIFE INSURANCE CO. | $1K | — | $1K | 2.07% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMIN INC | 721 S PARKER STE 300 ORANGE, CA 92868 | AETNA LIFE INSURANCE CO. | $631 | — | $631 | 1.04% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN BENEFIT ADMINI | 721 S PARKER ST STE 300 ORANGE, CA 928684732 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 4.35% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD LEE BROWN | 7560 CAMINO NORTE RCH CUCAMONGA, CA 917301025 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 4.11% |
| JAMES ALAN DILKS3 | 8546 CALLE CARABE ST RCH CUCAMONGA, CA 917301909 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 2.73% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN, FLOYD L | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 97186 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | INSURANCE ADMINISTRATORS 721 S. PARKER, SUITE 300 ORANGE, CA 92868 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $620 | $620 | 5.00% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $481 | $481 | $962 | 10.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN, FLOYD L | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 97186 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $481 | — | $481 | 5.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD BROWN | 255 W FOOTHILL BLVD #102 UPLAND, CA 91786 | CALIFORNIA DENTAL NETWORK, INC. | $357 | — | $357 | 5.00% |
| PALO VERDE INC3 | 255 W FOOTHILL BLVD #102 UPLAND, CA 91786 | CALIFORNIA DENTAL NETWORK, INC. | $357 | — | $357 | 5.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN, FLOYD L | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 97186 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $422 | — | $422 | 11.00% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $361 | — | $361 | 10.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN, FLOYD L | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 97186 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $361 | — | $361 | 10.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | INSURANCE ADMINISTRATORS 721 S. PARKER, SUITE 300 ORANGE, CA 92868 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $180 | $180 | 4.99% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN, FLOYD L | 255 W FOOTHILL BLVD STE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $57 | — | $57 | 7.57% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $57 | — | $57 | 7.57% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | INSURANCE ADMINISTRATORS 721 S. PARKER, SUITE 300 ORANGE, CA 92868 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $37 | $37 | 4.91% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 165 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 125 | $590K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 114 | $56K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 114 | $49K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 82 | $13K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 10 | $4K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 7 | $12K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 82 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.