| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KIM JETTON INSURANCE SRVCS INC3 | 8578 UTICA AVE STE 200 RANCHO CUCAMONGA, CA 91730 | CALIFORNIA PHYSICIANS' SERVICE | $93K | — | $93K | 5.33% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES, | LLC 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS' SERVICE | $37K | — | $37K | 2.11% |
| KIM V JETTON INSURANCE SERVICES INC3 Filed as: KIM V. JETTON INSURANCE SERVIC | PO BOX 1200 RANCHO CUCAMONGA, CA 91729 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 5.70% |
| KIM V JETTON INSURANCE SERVICES INC3 Filed as: KIM V. JETTON INSURANCE SERVIC | PO BOX 1200 RANCHO CUCAMONGA, CA 91729 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.09% |
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 | 230 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 39 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 269 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 287 | $1.7M |
| Dental(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 230 | $186K |
| Life insurance(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 230 | $186K |
| Long-term disability(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 230 | $186K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 287 | $1.7M |
| Other(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 230 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.