| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 12 MAUCHLY BUILDING I IRVINE, CA 92618 | BLUE CROSS OF CALIFORNIA | $220K | — | $220K | 4.63% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LARKSPUR LANDING CIRCLE STE 116 LARKSPUR, CA 94939 | SUN LIFE ASSURANCE COMPANY OF CANADA | $56K | — | $56K | 9.61% |
| HARRY LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | SUN LIFE ASSURANCE COMPANY OF CANADA | $24K | — | $24K | 4.12% |
| MGIS3 | 111 SOUTH MAIN STREET, SUITE 400 SALT LAKE CITY, UT 841112176 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $60 | $60 | 0.01% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LARKSPUR LANDING C STE 116 LARKSPUR, CA 94939 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27K | $24K | $51K | 16.67% |
| NORMAN LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $623 | $6K | 2.01% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS | 1125 NW COUCH STREET STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $6K | $6K | 1.91% |
| MULLINTBG INSURANCE AGENCY3 | 33174 COLLECTION CENTER DRIVE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $617 | $4K | 1.41% |
| KAREN G. HAIGH3 Filed as: KAREN HAIGH | 6011 COUNTRY VIEW DRIVE YORBA LINDA, CA 92886 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $461 | $78 | $539 | 0.18% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 5600 WEST 83RD STREET STE 1100 8200 TOWER BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $163 | — | $163 | 0.05% |
| MICHAEL RUBAUM HARRIS3 | 3639 LIVINGSON ROAD CENTRAL POINT, OR 97502 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 0.02% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 12 MAUCHLY BUILDING I IRVINE, CA 92618 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 3.25% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 12 MAUCHLY BUILDING I IRVINE, CA 92618 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 4.63% |
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 | 195 | 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) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 178 | $4.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 175 | $265K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $56K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 195 | $56K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 208 | $585K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 208 | $585K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 178 | $4.8M |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 195 | $363K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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.