| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP | 5110 40TH ST SUITE 234 PHOENIX, CA 850182151 | VISION SERVICE PLAN | $942 | $0 | $942 | 4.58% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC | 200 GALLERIA PKWY SE ATLANTA, GA 30339 | VISION SERVICE PLAN | $709 | $0 | $709 | 3.45% |
| LEWIS & KESMODEL INSURANCE SERVICES3 | 900 HOWE AVENUE STE 220 SACRAMENTO, CA 95825 | VISION SERVICE PLAN | $296 | $0 | $296 | 1.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROUNDSTONE INSURANCE EIN 27-0371422 CAPTIVE PLAN | Named fiduciary Service code 31 | 15422 DETROIT AVENUE LAKEWOOD, OH 44107 | $368K |
| LEWIS & KESMODEL INSURANCE SERVICES EIN 82-4322322 BROKER | Consulting (general) Service code 16 | 900 HOWE AVE SUITE 220 SACRAMENTO, CA 95825 | $47K |
| CALIFORNIA PHYSICIANS SERVICES EIN 94-0360524 NETWORK LEASE | Insurance services Service code 23 | 50 BEALE STREET SAN FRANCISCO, CA 94105 | $26K |
| LUCENT HEALTH EIN 39-1997579 THIRD PARTY CLAIMS ADMIN | Contract Administrator Service code 13 | 424 CHURCH ST #2300 NASHVILLE, TN 37219 | $26K |
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 81 | $21K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 110 | $5K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 5 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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.