| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TEVIS INSURANCE SOLUTIONS3 | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $24K | — | $24K | 5.19% |
| TEVIS INSURANCE SOLUTIONS3 | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 4.99% |
| TEVIS INSURANCE SOLUTIONS3 | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | — | $8K | 4.84% |
| TEVIS INSURANCE SOLUTIONS3 | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | AMERITAS LIFE INSURANCE CORP. | $4K | — | $4K | 5.00% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $10K | $22K | 72.54% |
| TEVIS INSURANCE SOLUTIONS3 | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | ANTHEM LIFE INSURANCE COMPANY | $666 | — | $666 | 5.19% |
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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 84 | $845K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 279 | $84K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 81 | $457K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 84 | $487K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 84 | $30K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 174 | $13K |
| Prescription drug(3 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 81 | $815K |
| Other(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 84 | $487K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.