| 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 | $265K | $1K | $266K | 5.93% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 435 WHITTINGTON PKWY SUITE 300 LOUISVILLE, KY 40222 | BLUE CROSS OF CALIFORNIA | — | $382 | $382 | 0.01% |
| 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 | $68K | — | $68K | 9.59% |
| HARRY LEVITT3 | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | SUN LIFE ASSURANCE COMPANY OF CANADA | $29K | — | $29K | 4.11% |
| 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 | 100 SMITH RANCH RD STE 340 SAN RAFAEL, CA 94903 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $48K | $25K | $73K | 16.30% |
| HARRY LEVITT3 Filed as: HARRY NORMAN LEVITT | 1600 CAPRI DRIVE PACIFIC PALISADES, CA 90272 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14K | $5K | $19K | 4.25% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS | 1125 NW COUCH STREET STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $12K | $12K | 2.61% |
| MULLINTBG INSURANCE AGENCY3 | 33174 COLLECTION CENTER DRIVE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $437 | $3K | 0.71% |
| 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 | 0.03% |
| MICHAEL RUBAUM HARRIS3 Filed as: MICHAEL HARRIS RUBAUM | 3639 LIVINGSON ROAD CENTRAL POINT, OR 97502 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.01% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | P.O. BOX 4328 TORRANCE, CA 90510 | PRINCIPAL LIFE INSURANCE COMPANY | $26K | — | $26K | 10.79% |
| AP BENEFIT ADVISORS, LLC3 | 10 NORTH PARK DR #200 HUNT VALLEY, MD 21030 | PRINCIPAL LIFE INSURANCE COMPANY | — | $1K | $1K | 0.58% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | 2355 CRENSHAW BLVD STE 300 TORRANCE, CA 90501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 10.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $46 | $46 | 0.09% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: KEENAN & ASSOCIATES | P.O. BOX 4328 TORRANCE, CA 90510 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | $7 | $1K | 5.93% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 435 WHITTINGTON PKWY SUITE 300 LOUISVILLE, KY 40222 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $2 | $2 | 0.01% |
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 | 244 | 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) | 246 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 465 | $4.5M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 459 | $239K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 413 | $22K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 290 | $52K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 243 | $710K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 243 | $710K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 465 | $4.5M |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 290 | $498K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 465 | — |
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.