| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES | 940 ADAMS STREET, SUITE G BENICIA, CA 94105 | STANDARD SECURITY LIFE | $43K | — | $43K | 8.00% |
| PRISM UNDERWRITING GROUP, LLC3 | 1202 W 33 PLACE CHICAGO, IL 60608 | MINNESOTA LIFE INSURANCE COMPANY | — | $5K | $5K | 5.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: BRIAN ULLRICH, AIS RISK MANAGEMENT | PO BOX 711 MODESTO, CA 95353 | VISION SERVICE PLAN | $2K | — | $2K | 2.83% |
| PRISM UNDERWRITING GROUP, LLC3 | 1202 W 33 PLACE CHICAGO, IL 60608 | MINNESOTA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
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 | 454 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 458 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF CALIFORNIA | 115 | $73K |
| Vision | VISION SERVICE PLAN | 532 | $82K |
| Life insurance(3 contracts, 2 carriers) | STANDARD SECURITY LIFE | 752 | $714K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 752 | — |
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.