| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRATED INSURANCE SVCS INC3 | PO BOX 609 SANTA BARBARA, CA 93102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | — | $5K | 1.33% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 10.00% |
| INTEGRATED INSURANCE SVCS INC3 | PO BOX 609 SANTA BARBARA, CA 93102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 8.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $184 | — | $184 | 0.81% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 9171 TOWNE CENTRE DRIVE, SUITE 500 SAN DIEGO, CA 92122 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $84 | — | $84 | 0.37% |
| BENEFIT ADVIORS NETWORK3 | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $1 | $1 | 0.00% |
| NEOVIA INTEGRATED INSURANCE SVCS.3 Filed as: NEOVIA INTEGRATED INS. SVCS INC. | PO BOX 8360 GOLETA, CA 93118 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $466 | — | $466 | 2.76% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.00% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.00% |
| JESSE RAMOS4 | 7331 SHELBY LN #26 RANCHO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $2K | — | $2K | 14.81% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $234 | — | $234 | 2.30% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 500 SAN DIEGO, CA 92122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $34 | — | $34 | 4.00% |
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 | 435 | 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) | 437 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 201 | $824K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 435 | $372K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 435 | $372K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 639 | $64K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 55 | $23K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 86 | $13K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 201 | $824K |
| Other(5 contracts, 4 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 633 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 639 | — |
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.