| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 500 SILVER SPUR ROAD, SUITE 121 ROLLING HILLS ESTATES, CA 90275 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | $4K | $9K | 11.68% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $5K | $5K | 7.05% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 500 SILVER SPUR ROAD, SUITE 121 ROLLING HILLS ESTATES, CA 90275 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $3K | $8K | 15.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.54% |
| ROGERS BENEFIT GROUP INC4 Filed as: M ROGERS GROUP, LLC | PO BOX 853 GEORGETOWN, OH 80444 | PRE-PAID LEGAL SERVICES INC | $456 | $0 | $456 | 14.04% |
| PATRIOT GROWTH INSURANCE SERVICES4 | 501 OFFICE CENTER DRIVE SUITE 215 FORT WASHINGTON, PA 19034 | PRE-PAID LEGAL SERVICES INC | $365 | $0 | $365 | 11.23% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 157 | $1.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 150 | $74K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 150 | $74K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $49K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $49K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $49K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 157 | $1.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.