| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, LLC | PO BOX 896620 CHARLOTTE, NC 282896620 | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | $20K | — | $20K | 2.30% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA BXA | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | AETNA HEALTH, INC. | $8K | — | $8K | 2.30% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. | 3744 MT DIABLO BLVD LAYFAYETTE, CA 94549 | AETNA HEALTH, INC. | $5K | $2K | $7K | 1.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA BXA | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | AETNA LIFE INSURANCE CO. | $3K | — | $3K | 2.42% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. | 3744 MT DIABLO BLVD LAYFAYETTE, CA 94549 | AETNA LIFE INSURANCE CO. | $2K | $1K | $3K | 2.31% |
| BENEFIT EXCHANGES ALLIANCE, INC.3 | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.79% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING, LLC | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CAL, LLC DBA BXA INSURA | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.77% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 150 S WARNER RD STE 460 KING OF PRUSSIA, PA 194062843 | METROPOLITAN LIFE INSURANCE COMPANY | $856 | $31 | $887 | 0.72% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | METROPOLITAN LIFE INSURANCE COMPANY | $428 | — | $428 | 0.35% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | PO BOX 986620 CHARLOTTE, NC 282896620 | METROPOLITAN LIFE INSURANCE COMPANY | — | $107 | $107 | 0.09% |
| BENEFIT EXCHANGES ALLIANCE, INC.3 | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $139 | — | $139 | 3.63% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING, LLC | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $131 | — | $131 | 3.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CAL, LLC DBA BXA INSURA | 23716 BIRTCHER DR LAKE FOREST, CA 926301771 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $123 | — | $123 | 3.21% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 150 S WARNER RD STE 460 KING OF PRUSSIA, PA 194062843 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $29 | — | $29 | 0.76% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $15 | — | $15 | 0.39% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | PO BOX 986620 CHARLOTTE, NC 282896620 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | — | $4 | $4 | 0.10% |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | 103 | $1.3M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 280 | $127K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 280 | $123K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 280 | $123K |
| Prescription drug | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | 103 | $854K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 280 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.