| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | BLUE SHIELD OF CALIFORNIA | $77K | $2K | $78K | 5.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | PRINCIPAL LIFE INSURANCE COMPANY | $32K | $0 | $32K | 10.80% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 20.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | EYEMED VISION CARE | $4K | $0 | $4K | 15.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | EYEMED VISION CARE | $3K | $0 | $3K | 11.52% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $288 | $0 | $288 | 8.18% |
| SHELTER MINISTRIES, INC.4 Filed as: SHELTER MINISTRIES INC. | 31441 SANTA MARGARITA PARKWAY SUITE A 244 RANCHO SANTA MARGARITA, CA 92688 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $220 | $0 | $220 | 6.25% |
| JESSE RAMOS4 | 7331 SHELBY LANE, #26 RANCO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $64 | $0 | $64 | 1.82% |
| BLAKE HENRY4 | 9 SUMMITCREST TRABUCO CANYON, CA 92679 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $28 | $0 | $28 | 0.80% |
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 | 168 | 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) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 304 | $1.5M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 373 | $296K |
| Vision | EYEMED VISION CARE | 332 | $23K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 373 | $296K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 373 | $296K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 373 | $296K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 304 | $1.5M |
| Other(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 373 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 373 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.