| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | HEALTH NET | $2K | — | $2K | 3.92% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $1K | $336 | $1K | 8.63% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $853 | $341 | $1K | 12.98% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $1K | $308 | $2K | 27.20% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $141 | $58 | $199 | 6.88% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $203 | — | $203 | 8.74% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | STANDARD INSURANCE COMPANY | $70 | — | $70 | 8.73% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 190 | $170K |
| Dental | STANDARD INSURANCE COMPANY | 102 | $17K |
| Vision | STANDARD INSURANCE COMPANY | 152 | $3K |
| Life insurance | STANDARD INSURANCE COMPANY | 193 | $9K |
| Short-term disability | STANDARD INSURANCE COMPANY | 71 | $802 |
| Long-term disability | STANDARD INSURANCE COMPANY | 59 | $2K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 190 | $170K |
| Other(2 contracts) | STANDARD INSURANCE COMPANY | 193 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.