| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROBITY INSURANCE SERVICES | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $179K | $10K | $189K | 20.50% |
| ROGERS BENEFIT GROUP INC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $60K | $60K | 6.48% |
| PROBITY INSURANCE SERVICES3 | 1100 E HAMILTON AVE STE 1 CAMPBELL, CA 95008 | PRINCIPAL LIFE INSURANCE COMPANY | $108K | $7K | $116K | 19.46% |
| ROGERS BENEFIT GROUP INC3 | 6155 ALMADEN EXPY STE 210 SAN JOSE, CA 95120 | PRINCIPAL LIFE INSURANCE COMPANY | $32K | — | $32K | 5.38% |
| PROBITY INSURANCE SERVICES3 | 1100 E HAMILTON AVE STE 1 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC | $21K | $36 | $21K | 5.02% |
| DONNA KHANDAN HOSSEINI3 | 1100 E HAMILTON AVE STE 1 CAMPBELL, CA 95008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $5K | $8K | 42.88% |
| JAN HEJRET3 | 644 N 17TH ST SAN JOSE, CA 95112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $4K | $5K | 29.03% |
| MANDEEP TEJA3 | 1548 SAINT FRANCIS DR SAN JOSE, CA 95125 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $3K | $5K | 28.57% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $673 | $392 | $1K | 5.78% |
| LISA LOUISE ROBBERSON3 | 13120 102ND LN NE APT 3 KIRKLAND, WA 98034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $975 | $28 | $1K | 5.45% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVE SPC 112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $490 | $36 | $526 | 2.86% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DR SE OLYMPIA, WA 98501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | $86 | $238 | 1.29% |
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 | 255 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 189 | $1.4M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 259 | $594K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 259 | $594K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 259 | $594K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 259 | $612K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 259 | $594K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 24 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.