| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | KAISER PERMANENTE | $37K | — | $37K | 3.64% |
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | CALIFORNIA PHYSICIANS SERVICE | $16K | — | $16K | 3.43% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | CALIFORNIA PHYSICIANS SERVICE | $3K | — | $3K | 0.66% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $8K | $623 | $8K | 30.26% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | VISION SERVICE PLAN | $844 | — | $844 | 3.69% |
| TAPERT INSURANCE AGENCY3 | 300 NORTH LAKE AVENUE, SUITE 210 PASADENA, CA 91101 | VISION SERVICE PLAN | $349 | — | $349 | 1.52% |
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $363 | $2K | 11.09% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $970 | — | $970 | 6.24% |
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | HOLMAN FAMILY COUNSELING CENTERS | $450 | — | $450 | 5.00% |
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $440 | $115 | $555 | 10.64% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $342 | — | $342 | 6.56% |
| TAPERT INSURANCE AGENCY3 | 14 N. BALDWIN AVENUE SIERRA MADRE, CA 91024 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $279 | $73 | $352 | 10.58% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $220 | — | $220 | 6.61% |
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 | 244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER PERMANENTE | 228 | $1.5M |
| Dental | AFLAC | 67 | $28K |
| Vision(2 contracts, 2 carriers) | AFLAC | 150 | $51K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 23 | $3K |
| Prescription drug(2 contracts, 2 carriers) | KAISER PERMANENTE | 228 | $1.5M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 370 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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.