| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: NORTH MURRAY & ASSOCIATES INC | 1971 E FOURTH STREET #290 SANTA ANA, CA 92705 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $8K | — | $8K | 3.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS INC | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $5K | $5K | 2.02% |
| GALLANT RISK & INSURANCE SERVICES3 | 4160 TEMESCAL CANYON ROAD SUITE 40 CORONA, CA 92883 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $854 | — | $854 | 0.37% |
| THE DEXHEIMER COMPANY3 Filed as: DEXHEIMER-ERICKSON CORP | 350 S FIGUEROA STREET SUITE 950 LOS ANGELES, CA 90071 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 10.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $103 | — | $103 | 6.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI OF SOUTHERN CALIFORNIA INS | 21700 OXNARD STREET 8TH FLOOR WOODLAND HILLS, CA 91367 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $46 | — | $46 | 3.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62649 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $31 | $31 | 2.08% |
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 | 99 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 34 | $229K |
| Dental | DELTA DENTAL OF CALIFORNIA | 77 | $28K |
| Vision | VISION SERVICE PLAN | 38 | $7K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 99 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.