| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GRAYBILL INSURANCE AGENCY, INC.3 Filed as: GRAYBILL INSURANCE AGENCY INC | 101 PARKSHORE DR SUITE 100 FOLSOM, CA 95630 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $28K | — | $28K | 9.08% |
| AMWINS3 Filed as: LISI INC | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $10K | $10K | 3.25% |
| GRAYBILL INSURANCE AGENCY, INC.3 Filed as: GRAYBILL INSURANCE AGENCY INC | 101 PARKSHORE DR SUITE 100 FOLSOM, CA 95630 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 4.96% |
| GRAYBILL INSURANCE AGENCY, INC.3 Filed as: GRAYBILL INSURANCE AGENCY INC | 101 PARKSHORE DR SUITE 100 FOLSOM, CA 95630 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | $27K | $6K | $33K | 18.03% |
| DWAYNE GRAYBILL3 | 101 PARKSHORE DR SUITE100 FOLSOM, CA 95630 | KAISER FOUNDATION HEALTH PLAN OF NORTHWEST | $5K | $0 | $5K | 3.25% |
| DWAYNE GRAYBILL3 | 101 PARKSHORE DR FOLSOM, CA 95630 | TRUSTMARK INSURANCE COMPANY | — | — | $0 | 0.00% |
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 | 148 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 60 | $711K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $181K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $181K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $187K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $181K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $181K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA NEW YORK | 148 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.