| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MVI ADMINISTRATORS, INC.5 | 1011 CAMINO DEL RIO SOUTH STE 300 SAN DIEGO, CA 92108 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $27K | — | $27K | 3.44% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE OF SO CA | 1820 E FIRST ST SUITE 500 SANTA ANA, CA 92705 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $16K | — | $16K | 2.03% |
| MVI ADMINISTRATORS, INC.5 Filed as: MVI ADMINISTRATOR, INC. | 1011 CAMINO DEL RIO STREET STE 300 SAN DIEGO, CA 92108 | KAISER - MEDICAL | $7K | — | $7K | 3.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SER | 700 W 47TH STREET STE 1100 KANSAS CITY, OH 64112 | UNION SECURITY INSURANCE COMPANY | $1K | — | $1K | 3.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MVI ADMINISTRATORS, INC EIN 33-0393692 ADMINISTRATOR | Plan Administrator Service code 14 | 1011 CAMINO DEL RIO SOUTH STE 300 SAN DIEGO, CA 92108 | $56K |
| CBIZ BENEFITS & INSURANCE SERVICES, EIN 31-1582098 INSURANCE | Insurance brokerage commissions and fees Service code 53 | PO BOX 632886 CINCINNATI, OH 452632886 | $23K |
| MELISSA W. COOK & ASSOCIATES, INC EIN 95-3245809 ATTORNEY | Legal Service code 29 | 3444 CAMINO DEL RIO N 106 SAN DIEGO, CA 921081711 | $9K |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 89 | $978K |
| Dental(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 89 | $978K |
| Vision | UNION SECURITY INSURANCE COMPANY | 135 | $31K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 89 | $779K |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 89 | $779K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.