| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RODNEY MATTOS3 | 6119 HORSESHOE BAR RD LOOMIS, CA 95650 | BLUE CROS AND BLUE SHIELD OF NORTH CAROLINA | $171K | — | $171K | 8.14% |
| ELITE CONSULTING AND INSURANCE3 | PO BOX 1729 LOOMIS, CA 95650 | PRINCIPAL LIFE INSURANCE COMPANY | $25K | — | $25K | 9.14% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | PO BOX 2291 DURHAM, NC 27702 | PRINCIPAL LIFE INSURANCE COMPANY | — | $14K | $14K | 4.86% |
| SUTTER MCLELLAN & GILBREATH INC3 Filed as: SUTTER HEALTH PLAN | — | CALIFORNIA CHOICE | $3K | — | $3K | 2.71% |
| KAISER ARMAC INSURANCE AGENCY3 Filed as: KAISER PERMANENTE | — | CALIFORNIA CHOICE | $2K | — | $2K | 1.48% |
| WESTERN HEALTH ADVANTAGE3 | — | CALIFORNIA CHOICE | $942 | — | $942 | 0.81% |
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 | 201 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROS AND BLUE SHIELD OF NORTH CAROLINA | 189 | $2.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $278K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $278K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $278K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $278K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $278K |
| Prescription drug | BLUE CROS AND BLUE SHIELD OF NORTH CAROLINA | 189 | $2.1M |
| Other | BLUE CROS AND BLUE SHIELD OF NORTH CAROLINA | 189 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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.