| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DERENDINGER INSURANCE AGENCY, INC.3 | 1133 SARATOGA AVENUE BOX 9307 SAN JOSE, CA 95157 | STANDARD INSURANCE COMPANY | $55K | — | $55K | 10.09% |
| EDWARD S. RICE JR.3 Filed as: EDWARD S. RICE, JR. | 4050 KATELLA AVE., SUITE 213 LOS ALAMITOS, CA 90720 | AMERICAN HERITAGE LIFE INSURANCE | $20K | — | $20K | 3.70% |
| DERENDINGER INSURANCE AGENCY, INC.3 | 1133 SARATOGA AVENUE BOX 9307 SAN JOSE, CA 95129 | AMERICAN HERITAGE LIFE INSURANCE | $15K | — | $15K | 2.78% |
| TERI B. KIDD3 | 3012 SANDHURST CT. SACRAMENTO, CA 95821 | AMERICAN HERITAGE LIFE INSURANCE | $5K | — | $5K | 0.83% |
| ROBERT B. SUHR & COMPANY3 Filed as: ROBERT VARICH | 1125 SARATOGA AVENUE SAN JOSE, CA 95129 | AMERICAN HERITAGE LIFE INSURANCE | $2K | — | $2K | 0.28% |
| DUANE M. BAUTISTA3 | 6 CANDLEWOOD LANE ALISO VIEJO, CA 92656 | AMERICAN HERITAGE LIFE INSURANCE | $1K | — | $1K | 0.19% |
| MARK MASAO ENDO3 | 761 W. HAMILTON AVE., STE. 1 SAN PEDRO, CA 90731 | AMERICAN HERITAGE LIFE INSURANCE | $500 | — | $500 | 0.09% |
| DERENDINGER INSURANCE AGENCY, INC.3 | 1133 SARATOGA AVENUE BOX 9307 SAN JOSE, CA 95157 | REASSURE AMERICA LIFE INSURANCE COMPANY | $10K | — | $10K | 20.00% |
| DERENDINGER INSURANCE AGENCY, INC.3 | 1133 SARATOGA AVENUE BOX 9307 SAN JOSE, CA 95129 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | $2K | — | $2K | 11.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZAJAC GROUP EIN 77-0354155 N/A | Accounting (including auditing) Service code 10 | 17485 MONTEREY RD. 203 MORGAN HILL, CA 95037 | $19K |
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 | 912 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 912 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN HERITAGE LIFE INSURANCE | 400 | $540K |
| Life insurance | STANDARD INSURANCE COMPANY | 3,000 | $545K |
| Other(2 contracts, 2 carriers) | REASSURE AMERICA LIFE INSURANCE COMPANY | 500 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,000 | — |
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.