| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYWARD TILTON & ROLAPP INSURANCE3 Filed as: HAYWARD TILTON & ROLAPP INS. ASSOC. | 1551 N. TUSTIN AVENUE, SUITE 500 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $14K | — | $14K | 2.04% |
| LOCKTON COMPANIES, LLC3 | 8110 E. UNION, SUITE 700 DENVER, CO 80237 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 0.69% |
| AMWINS3 Filed as: LISI INC. | 1600 WEST HILLSDALE BLVD. SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $4K | — | $4K | 0.52% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CA INSURANCE SERVICES INC. | 3470 MT. DIABLO BLVD., SUITE A100 LAFAYETTE, CA 94549 | BLUE CROSS OF CALIFORNIA | $3K | $16 | $3K | 0.49% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CA INSURANCE SERVICES INC. | 3 ALTARINDA ROAD ORINDA, CA 94563 | BLUE CROSS OF CALIFORNIA | $26 | — | $26 | 0.00% |
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 | 153 | 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) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 186 | $689K |
| Dental | BLUE CROSS OF CALIFORNIA | 186 | $689K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 112 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.