| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 | 2745 W 600 N LINDON, UT 84042 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21K | $3K | $23K | 10.33% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: VITA INSURACE ASSOCIATES, INC | 1451 GRANT RD SUITE 200 MOUNTAIN VIEW, CA 94040 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14K | $5K | $20K | 8.70% |
| TCS INSURANCE AGENCY INC3 | 100 SMITH RANCH RD STE 340 SAN RAFAEL, CA 949031900 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $9K | $19K | 13.73% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $949 | $949 | 0.69% |
| TCS INSURANCE AGENCY INC3 | 100 SMITH RANCH RD SUITE 340 SAN RAFAEL, CA 949031900 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $4K | $10K | 19.08% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $1K | $1K | 2.00% |
| TCS INSURANCE AGENCY INC3 | 100 SMITH RAND RD SUITE 340 SAN RAFAEL, CA 949031900 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $141 | $187 | $328 | 9.76% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $9 | $9 | 0.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST 3 | Consulting fees; Participant communication; Insurance brokerage commissions and fees; Consulting (general) Service code 16 | 21300 VICTORY BLVD SUITE 700 WOODLAND HILLS, CA 91367 | $215K |
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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 574 | $5.8M |
| Dental | METROPOLITAN LIFE NSURANCE COMPANY | 489 | $1.1M |
| Vision | VISION SERVICE PLAN | 216 | $29K |
| Life insurance | METROPOLITAN LIFE NSURANCE COMPANY | 489 | $1.1M |
| Short-term disability | METROPOLITAN LIFE NSURANCE COMPANY | 489 | $1.1M |
| Long-term disability | METROPOLITAN LIFE NSURANCE COMPANY | 489 | $1.1M |
| Other(6 contracts, 2 carriers) | METROPOLITAN LIFE NSURANCE COMPANY | 489 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 574 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.