| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PALO VERDE INC3 Filed as: PALO VERDE, INC. | 8546 CALLE CARABE ST RANCHO CUCAMONGA, CA 917301909 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 2.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD BROWN | 7560 CAMINO NORTE RANCHO CUCAMONGA, CA 917301025 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 2.16% |
| 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 | $7K | $2 | $7K | 1.08% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN BENEFIT | ADMINISTRATORS INC 721 S PARKER ST STE 300 ORANGE, CA 928684732 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $248 | $3K | 4.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FLOYD LEE BROWN | 7560 CAMINO NORTE RCH CUCAMONGA, CA 917301025 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.31% |
| JAMES ALAN DILKS3 | 8546 CALLE CARABE ST RCH CUCAMONGA, CA 917301909 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 2.00% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 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 | $2K | — | $2K | 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 | — | $874 | $874 | 5.00% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $712 | $712 | $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 | $712 | — | $712 | 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. | $615 | — | $615 | 5.00% |
| PALOS VERDE INC3 | 255 W FOOTHILL BLVD #102 UPLAND, CA 91786 | CALIFORNIA DENTAL NETWORK, INC. | $615 | — | $615 | 5.00% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $435 | — | $435 | 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 | $435 | — | $435 | 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 | — | $218 | $218 | 5.02% |
| 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 | $437 | — | $437 | 11.00% |
| 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 | $51 | — | $51 | 7.41% |
| DILKS, JAMES A3 | 255 W FOOTHILL BLVD SUITE 102 UPLAND, CA 91786 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $51 | — | $51 | 7.41% |
| 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 | — | $34 | $34 | 4.94% |
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 | 226 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 22 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 146 | $633K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 163 | $98K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 163 | $85K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 195 | $18K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 20 | $4K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 16 | $17K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 195 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.