| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRAKKE SCHAFNITZ INSURANCE BROKERS3 | 28202 CABOT ROAD, SUITE 500 LAGUNA NIGUEL, CA 92677 | BLUE CROSS OF CALIFORNIA | $155K | — | $155K | 3.72% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LARKSPUR LANDING CIRCLE LARKSPUR, CA 94939 | SUN LIFE ASSURANCE COMPANY OF CANADA | $47K | — | $47K | 9.59% |
| HARRY LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | SUN LIFE ASSURANCE COMPANY OF CANADA | $20K | — | $20K | 4.11% |
| MGIS5 | 111 SOUTH MAIN STEET SALT LAKE CITY, UT 94111 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $60 | $60 | 0.01% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LARKSPUR LANDING LARKSPUR, CA 94939 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26K | $17K | $43K | 17.24% |
| MULLINTBG INSURANCE AGENCY3 | 33174 COLLECTION CENTER DRIVE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $2K | $9K | 3.42% |
| NORMAN LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $603 | $5K | 1.89% |
| KAREN G. HAIGH3 Filed as: KAREN HAIGH | 6011 COUNTRY VIEW DRIVE YORBA LINDA, CA 92886 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $389 | $128 | $517 | 0.21% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 5600 WEST 83RD STREET BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $123 | — | $123 | 0.05% |
| MICHAEL RUBAUM HARRIS3 | 3639 LIVINGSON ROAD CENTRAL POINT, OR 97502 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $51 | — | $51 | 0.02% |
| BRAKKE SCHAFNITZ INSURANCE BROKERS3 | 28202 CABOT ROAD, SUITE 500 LAGUNA NIGUEL, CA 92677 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $5K | $13K | 5.36% |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 179 | $4.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 169 | $239K |
| Vision | BLUE CROSS OF CALIFORNIA | 179 | $4.2M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 179 | $4.2M |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $485K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 190 | $485K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 179 | $4.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 179 | $4.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.