| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP DESIGN PROFESSIONALS INSURANCE3 Filed as: AP DESIGN PROFESSIONALS INS SVCS | 3697 MT DIABLO BLVD STE 230 LAFAYETTE, CA 94549 | CALIFORNIA PHYSICIANS' SERVICE | — | $30K | $30K | 2.39% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMINISTRATO | 701 S PARKER ST 8TH FL ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE | $23K | — | $23K | 1.89% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS CAPITAL, INC. | 196 S FIR ST VENTURA, CA 930012842 | KAISER FOUNDATION HEALTH PLAN, INC. | $19K | — | $19K | 2.89% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS CAPITAL, INC. | PO BOX 1388 VENTURA, CA 930021388 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 0.25% |
| AP DESIGN PROFESSIONALS INSURANCE3 Filed as: AP DESIGN PROFESSIONALS INS SVCS | 3697 MT DIABLO BLVD STE 230 LAFAYETTE, CA 94549 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | $2K | $17K | 11.91% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FINANCIAL | 12404 PARK CENTRAL DRIVE SUITE #400S DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 5.00% |
| AP DESIGN PROFESSIONALS INSURANCE3 Filed as: AP DESIGN PROFESSIONALS INS SVCS | 3697 MT DIABLO BLVD STE 230 LAFAYETTE, CA 94549 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $2K | — | $2K | 8.70% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN, INSURANCE ADMINISTRAT | 701 A PARKER ST 8TH FL ORANGE, CA 92868 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $324 | — | $324 | 1.16% |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 99 | $1.9M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 117 | $146K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 117 | $146K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 174 | $174K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 99 | $1.2M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 174 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.