| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, 12TH FLOOR SAN FRANCISCO, CA 94111 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $7K | — | $7K | 1.32% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $1K | $7K | 12.14% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $553 | $5K | 20.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 45 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $135 | $1K | 5.16% |
| WOODRUFF-SAWYER & CO3 | PO BOX 609 SANTA BARBARA, CA 93102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $215 | — | $215 | 0.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.28% |
| 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 | $36 | — | $36 | 0.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $272 | $4K | 21.69% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $228 | $1K | 11.96% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $256 | $1K | 12.36% |
| JESSE RAMOS4 | 7331 SHELBY LN #26 RANCHO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $934 | — | $934 | 11.27% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $125 | — | $125 | 1.51% |
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. | 155 | $627K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 447 | $514K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 447 | $514K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 721 | $59K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 96 | $23K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 93 | $12K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 155 | $627K |
| Other(5 contracts, 4 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 685 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 721 | — |
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."
No prospect flags tripped on this filing.