| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS E MESTMAKER INSURANCE AGENCY3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 57.13% |
| DANIEL PETREY3 | 1675 CHESTER AVE., STE 400 BAKERSFIELD, CA 93301 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 42.88% |
| THOMAS E MESTMAKER INSURANCE AGENCY3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $18 | — | $18 | 20.22% |
| DANIEL PETREY3 | 1675 CHESTER AVE., STE 400 BAKERSFIELD, CA 93301 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13 | — | $13 | 14.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | P. O. BOX 45018 FRESNO, CA 93718 | $103K |
| WALTER MORTENSEN INSURANCE EIN 74-3015339 BROKER | Other fees; Direct payment from the plan Service code 50 | 8500 STOCKDALE HIGHWAY, SUITE 200 BAKERSFIELD, CA 93311 | $101K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 PPO/UR VENDOR | Direct payment from the plan; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Insurance agents and brokers Service code 12 | — | $91K |
| PREMIER ACCESS INSURANCE COMPANY EIN 91-1857813 | Contract Administrator; Insurance agents and brokers; Direct payment from the plan; Claims processing; Other services Service code 12 | — | $6K |
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 | 350 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 350 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 983 | $215K |
| Vision | VISION SERVICE PLAN | 381 | $41K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 106 | $10K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 106 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 983 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.