| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KARR, TINA L3 | 30168 THORNE CT. CASTAIC, CA 91384 | CALIFORNIA PHYSICIANS SERVICE | $0 | $40K | $40K | 2.63% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE SERV | 2945 TOWNSGATE ROAD STE 200 WESTLAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS SERVICE | $0 | $58 | $58 | 0.00% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE SERVICES | 2945 TOWNSGATE RD STE 200 WESTLAKE VLG, CA 91361 | PRINCIPAL LIFE INSURNACE COMPANY | $6K | $34 | $6K | 5.65% |
| TINA KARR3 Filed as: TINA LESLEE KARR | 26045 MAGDALENA DR VALENCIA, CA 91355 | PRINCIPAL LIFE INSURNACE COMPANY | $6K | $34 | $6K | 5.65% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY GROUP BENEFITS L.L.C. | 2945 TOWNSGATE RD 200 WESTLAKE VILLAGE, CA 91361 | EYEMED | $854 | — | $854 | 4.87% |
| TINA KARR3 Filed as: TINA KARR - BOR | 15821 PORTOFINO SPRINGS BL. #107 FORT MYERS, FL 33908 | EYEMED | $854 | — | $854 | 4.87% |
| AFFINITY GROUP BENEFITS LLC3 Filed as: AFFINITY BENEFIT INSURANCE | 2945 TOWNSGATE ROAD SUITE 200 WESTLAKE VILLAGE, CA 91361 | CALIFORNIA DENTAL NETWORK, INC. | $691 | — | $691 | 5.00% |
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 | 133 | 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. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 212 | $1.5M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURNACE COMPANY | 209 | $119K |
| Vision | EYEMED | 220 | $18K |
| Life insurance | PRINCIPAL LIFE INSURNACE COMPANY | 209 | $105K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 212 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.