| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY, INC. | 900 NORTH MICHIGAN AVENUE 12TH FLOOR CHICAGO, IL 60611 | CALIFORNIA PHYSICIANS SERVICE | $154K | $0 | $154K | 5.00% |
| WELDON G KERR3 Filed as: WELDON G. KERR | 6155 ALMADEN EXPRESSWAY, SUITE 210 SAN JOSE, CA 95120 | CALIFORNIA PHYSICIANS SERVICE | $59K | $0 | $59K | 1.90% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 NORTH MICHIGAN AVENUE SUITE 1500 CHICAGO, IL 60611 | KAISER FOUNDATION HEALTH PLAN INC | $37K | $0 | $37K | 4.87% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | LOCKPOX 740659 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $113 | $113 | 0.01% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY, INC. | 900 NORTH MICHIGAN AVENUE 12TH FLOOR CHICAGO, IL 60611 | PRINCIPAL LIFE INSURANCE COMPANY | $60K | $0 | $60K | 10.02% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $745 | $745 | 0.12% |
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 | 710 | 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) | 710 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 523 | $3.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 523 | $3.8M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 920 | $597K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 920 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.