| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | P.O. BOX 4328 TORRANCE, CA 90510 | BLUE CROSS OF CALIFORNIA | $122K | — | $122K | 2.52% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 111 CORPORATE DR STE 100 LADERA RANCH, CA 92694 | BLUE CROSS OF CALIFORNIA | $122K | — | $122K | 2.52% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 100 SMITH RANCH RD. STE 340 SAN RAFAEL, CA 94903 | SUN LIFE ASSURANCE COMPANY OF CANADA | $63K | — | $63K | 9.60% |
| HARRY LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | SUN LIFE ASSURANCE COMPANY OF CANADA | $27K | — | $27K | 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 | $37K | $40K | $77K | 21.50% |
| HARRY LEVITT3 Filed as: HARRY NORMAN LEVITT | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $5K | $15K | 4.15% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS | 1125 NW COUCH STREET STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $7K | $7K | 1.91% |
| MULLINTBG INSURANCE AGENCY3 | 33174 COLLECTION CENTER DRIVE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $475 | $4K | 0.99% |
| KAREN G. HAIGH3 Filed as: KAREN GOSS HAIGH | 6011 COUNTRY VIEW DRIVE YORBA LINDA, CA 92886 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $106 | $78 | $184 | 0.05% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 5600 WEST 83RD STREET STE 1100 8200 TOWER BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $150 | — | $150 | 0.04% |
| MICHAEL RUBAUM HARRIS3 Filed as: MICHAEL HARRIS RUBAUM | 3639 LIVINGSON ROAD CENTRAL POINT, OR 97502 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.02% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 111 CORPORATE DR STE 100 LADERA RANCH, CA 92694 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 1.73% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | P.O. BOX 4328 TORRANCE, CA 90510 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 0.84% |
| ASSURANCE AGENCY LTD3 Filed as: INFINITY ASSURANCE GROUP | 111 CORPORATE DR STE 100 LADERA RANCH, CA 92694 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.52% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | P.O. BOX 4328 TORRANCE, CA 90510 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.52% |
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 | 230 | 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) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 433 | $4.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 449 | $279K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 787 | $59K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 787 | $59K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 230 | $658K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 230 | $658K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 433 | $4.8M |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 787 | $418K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 787 | — |
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.