| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II, INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | CALIFORNIA PHYSICIANS' SERVICE | $84K | $129 | $84K | 2.66% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II, INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 5.00% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II, INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 5.00% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II, INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | $0 | $6K | 11.62% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $2K | $7K | 15.00% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $1K | $6K | 20.00% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II, INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | $252 | $2K | 11.57% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: BXA INSURANCE SERVIES | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $744 | $3K | 19.99% |
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 | 509 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 42 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 557 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 463 | $3.2M |
| Dental(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 186 | $170K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 427 | $20K |
| Life insurance | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 232 | $50K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 153 | $44K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $32K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 463 | $3.2M |
| Other(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 232 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.