| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: TBG DANCO INSURANCE SERVICES CORP | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | KAISER FOUNDATION HEALTH PLAN | $109K | $0 | $109K | 4.00% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: TBG DANCO INSURANCCE SERVICES CORP | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | KAISER FOUNDATION HEALTH PLAN INC | $16K | $0 | $16K | 4.00% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $0 | $19K | 13.79% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $650 | $14K | 15.76% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | VISION SERVICE PLAN | $3K | $0 | $3K | 10.00% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $5K | $0 | $5K | 13.87% |
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 | 257 | 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) | 257 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN | 532 | $3.1M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 315 | $170K |
| Vision | VISION SERVICE PLAN | 172 | $34K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 257 | $86K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 257 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 532 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.