| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | KAISER FOUNDATION HEALTH PLAN | $30K | $0 | $30K | 4.88% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | AETNA HEALTH, INC. | $23K | $0 | $23K | 5.94% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $16K | $1K | $18K | 15.33% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | AETNA LIFE INSURANCE CO. | $5K | $0 | $5K | 5.83% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| THE EMPLOYERS BENEFIT GROUP, LLC3 Filed as: THE EMPLOYERS BENEFIT GROUP LLC | 11150 SANTA MONICA BLVD STE 800 LOS ANGELES, CA 90025 | CIGNA DENTAL HEALTH OF CALIFORNIA INC | $2K | $0 | $2K | 15.00% |
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 | 260 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN | 96 | $1.1M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 128 | $128K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 128 | $115K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 261 | $18K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN | 96 | $1.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 261 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 261 | — |
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.