| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD A PTAK3 | 6 REFLECTION LANE COTO DE CAZA, CA 92679 | BLUE CROSS OF CALIFORNIA | $20K | — | $20K | 3.62% |
| RON EIDO3 | 204 MAIN STREET SUITE 665 NEWPORT BEACH, CA 92661 | BLUE CROSS OF CALIFORNIA | $20K | — | $20K | 3.62% |
| AMWINS3 Filed as: LISI INC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | — | $13K | $13K | 2.49% |
| RON EIDO3 | 1355 EAST BALBOA AVENUE SUITE A NEWPORT BEACH, CA 92661 | BLUE CROSS OF CALIFORNIA | $10K | — | $10K | 1.92% |
| RICHARD PTAK3 | 23161 MILL CREEK DRIVE SUITE 100 LAGUNA HILLS, CA 92653 | BLUE CROSS OF CALIFORNIA | $10K | — | $10K | 1.92% |
| AMWINS3 Filed as: LISI INC | 1600 WEST HILLSDAGE BOULEVARD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | — | $7K | $7K | 1.32% |
| PREFERRED CHOICE BENEFITS3 | 204 MAIN STREET SUITE 665 NEWPORT BEACH, CA 92661 | VSP | $340 | — | $340 | 5.00% |
| RICK PTAK3 | 6 REFLECTION LANE COTO DE CAZA, CA 92679 | VSP | $340 | — | $340 | 5.00% |
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 | 98 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 74 | 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)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 94 | $1.0M |
| Dental | BLUE CROSS OF CALIFORNIA | 47 | $542K |
| Vision(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 94 | $512K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 94 | $505K |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 94 | $505K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.