| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE CROSS OF CALIFORNIA | $130K | $2K | $132K | 2.83% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 12 MAUCHLY, BLDG. I IRVINE, CA 92618 | BLUE CROSS OF CALIFORNIA | $59K | — | $59K | 1.26% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LARKSPUR LANDING CIRCLE LARKSPUR, CA 94939 | SUN LIFE ASSURANCE COMPANY OF CANADA | $53K | — | $53K | 9.60% |
| HARRY LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | SUN LIFE ASSURANCE COMPANY OF CANADA | $23K | — | $23K | 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 | $29K | $31K | $60K | 20.42% |
| NORMAN LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $2K | $7K | 2.49% |
| MULLINTBG INSURANCE AGENCY3 | 33174 COLLECTION CENTER DRIVE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $841 | $6K | 2.20% |
| KAREN G. HAIGH3 Filed as: KAREN HAIGH | 6011 COUNTRY VIEW DRIVE YORBA LINDA, CA 92886 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $425 | $85 | $510 | 0.17% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 5600 WEST 83RD STREET BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $211 | — | $211 | 0.07% |
| MICHAEL RUBAUM HARRIS3 | 3639 LIVINGSON ROAD CENTRAL POINT, OR 97502 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.02% |
| AC3 | 28202 CABOT ROAD, SUITE 500 LAGUNA NIGUEL, CA 92677 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $5K | $11K | 3.97% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 12 MAUCHLY, BLDG. I IRVINE, CA 92618 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $53 | $3K | 0.99% |
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 | 203 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 191 | $4.7M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 180 | $273K |
| Vision | BLUE CROSS OF CALIFORNIA | 191 | $4.7M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 191 | $4.7M |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 203 | $552K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 203 | $552K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 191 | $4.7M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 191 | $4.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.