| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| XL BENEFIT INSURANCE SERVICES | 10471 GRANT LINE ROAD SUITE 100 ELK GROVE, CA 95624 | PAN-AMERICAN LIFE INSURANCE COMPANY | $22K | $4K | $26K | 20.00% |
| BARTHULI & ASSOCIATES INSURANCE3 Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| ANCILLARY INSURANCE SOLUTIONS3 | 1440 E VALLEY FORGE DR FRESNO, CA 93720 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| BARTHULI & ASSOCIATES INSURANCE3 Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ANCILLARY INSURANCE SOLUTIONS3 | 1440 E VALLEY FORGE DR FRESNO, CA 93720 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $702 | $702 | 5.00% |
| BARTHULI & ASSOCIATES INSURANCE Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | AMERITAS LIFE INSURANCE CORP | $1K | — | $1K | 10.00% |
| BARTHULI & ASSOCIATES INSURANCE3 Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $898 | — | $898 | 10.00% |
| ANCILLARY INSURANCE SOLUTIONS3 | 1440 E VALLEY FORGE DR FRESNO, CA 93720 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $449 | $449 | 5.00% |
| BARTHULI & ASSOCIATES INSURANCE Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | AMERITAS LIFE INSURANCE CORP | $998 | $0 | $998 | 18.18% |
| BARTHULI & ASSOCIATES INSURANCE3 Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $306 | — | $306 | 9.98% |
| ANCILLARY INSURANCE SOLUTIONS3 | 1440 E VALLEY FORGE DR FRESNO, CA 93720 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $153 | $153 | 4.99% |
| BARTHULI & ASSOCIATES INSURANCE3 Filed as: BARTHULI & ASSOCIATES INSURANCE SVC | 5250 N PALM AVE FRESNO, CA 93704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $193 | — | $193 | 10.02% |
| ANCILLARY INSURANCE SOLUTIONS3 | 1440 E VALLEY FORGE DR FRESNO, CA 93720 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $96 | $96 | 4.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ADVANTEK BENEFIT ADMINISTRATORS EIN 77-0382381 ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 7370 N PALM AVE FRESNO, CA 93711 | $33K |
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 SERVICE PROVIDER | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services; Claims processing Service code 12 | 21215 BURBANK BLVD WOODLAND HILLS, CA 91367 | $23K |
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 | 55 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 55 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $0 |
| Dental | AMERITAS LIFE INSURANCE CORP | 63 | $5K |
| Vision | AMERITAS LIFE INSURANCE CORP | 136 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $48K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 12 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 17 | $9K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 87 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136 | — |
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.