| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREINI AND COMPANY3 | 220 WEST 20TH AVENUE SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $88K | $0 | $88K | 4.59% |
| MICHAEL COLLINS MCNERLIN3 | PO BOX 61 UKIAH, CA 95482 | AFLAC | $3K | $96 | $3K | 7.04% |
| PAUL F. MCNERLIN3 | PO BOX 353 UKIAH, CA 95482 | AFLAC | $1K | $0 | $1K | 2.76% |
| ASSUREDPARTNERS3 Filed as: JASON V. SHEPHERD | PO BOX 1452 UKIAH, CA 95482 | AFLAC | $858 | $21 | $879 | 2.24% |
| MJ INSURANCE3 Filed as: MARK C. HUBER AND VARIOUS AGENTS | 1100 COLD SPRINGS ROAD PLACERVILLE, CA 95667 | AFLAC | $650 | $11 | $661 | 1.68% |
| ALEJANDRO JOSE LOPEZ3 | 757 LAKE MENDOCINO DRIVE UKIAH, CA 95482 | AFLAC | $360 | $11 | $371 | 0.94% |
| SAHAR QABAZARD3 | 3756 DEER TRAIL COURT DANVILLE, CA 94506 | AFLAC | $276 | $21 | $297 | 0.76% |
| JON ERIC ILLG3 | PO BOX 100 ONTARIO, CA 91762 | AFLAC | $237 | $0 | $237 | 0.60% |
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 407 | $1.9M |
| Dental | BLUE CROSS OF CALIFORNIA | 407 | $1.9M |
| Vision | BLUE CROSS OF CALIFORNIA | 407 | $1.9M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 407 | $1.9M |
| Short-term disability | AFLAC | 26 | $39K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 407 | $1.9M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 407 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.