| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 125 HIGH STREET 22ND FLOOR BOSTON, MA 02110 | BLUE CROSS OF CALIFORNIA | $32K | $201 | $32K | 3.64% |
| LOCKTON COMPANIES, LLC3 | 777 SOUTH FIGUEROA STREET SUITE 5200 LOS ANGELES, CA 90017 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | $0 | $11K | 2.58% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | $0 | $7K | 1.56% |
| LOCKTON COMPANIES, LLC3 | 3 EMBARCADERO CENTER, SUITE 609 SAN FRANCISCO, CA 94111 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 7.64% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET 6TH FLOOR SANDIEGO, CA 92101 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $2K | $4K | 5.41% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $27 | $27 | 0.04% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | DELTA DENTAL OF CALIFORNIA | $5K | $0 | $5K | 6.96% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | DELTA DENTAL OF CALIFORNIA | $751 | $0 | $751 | 1.04% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | VISION SERVICE PLAN | $543 | $0 | $543 | 6.92% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | VISION SERVICE PLAN | $198 | $0 | $198 | 2.52% |
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 | 0 | 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. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 90 | $1.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 88 | $72K |
| Vision | VISION SERVICE PLAN | 78 | $8K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $73K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $73K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $73K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 199 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.