| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JENNIFER MCDONALD Filed as: JENNIFER MEI MATSUMOTO | 15615 ALTON PKWY SUITE # 450 IRVINE, CA 92618 | AETNA HEALTH, INC. | $24K | $0 | $24K | — |
| AMWINS Filed as: LISI, LLC | 1600 WEST HILLSDALE BLVD SUITE # 201 SAN MATEO, CA 94402 | AETNA HEALTH, INC. | $4K | $0 | $4K | — |
| AMWINS Filed as: AMWINS CONNECT INSURANCE LLC | 1600 WEST HILLSDALE BLVD SUITE # 201 SAN MATEO, CA 94402 | AETNA HEALTH, INC. | $1K | $0 | $1K | — |
| JENNIFER MCDONALD Filed as: JENNIFER MEI MATSUMOTO | 15615 ALTON PKWY SUITE # 450 IRVINE, CA 92618 | AETNA LIFE INSURANCE CO. | $624 | $0 | $624 | — |
| AMWINS Filed as: LISI, LLC | 1600 WEST HILLSDALE BLVD SUITE # 201 SAN MATEO, CA 94402 | AETNA LIFE INSURANCE CO. | $92 | $0 | $92 | — |
| AMWINS Filed as: AMWINS CONNECT INSURANCE LLC | 1600 WEST HILLSDALE BLVD SUITE # 201 SAN MATEO, CA 94402 | AETNA LIFE INSURANCE CO. | $33 | $0 | $33 | — |
| MATUSOMOTO JENNIFER | 15615 ALTON PKWY SUITE # 450 IRVINE, CA 92618 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | $0 | $1K | — |
| CENTERSTONE INSURANCE AND FINANCIAL | 12404 PARK CENTRAL DR SUITE 400S DALLAS, TX 75251 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $503 | $503 | — |
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 | 61 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 61 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 1 | $0 |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 103 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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.