| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 | 3281 E GUASTI RD SUITE 400 ONTARIO, CA 917617625 | HEALTH PLAN OF NEVADA/SIERRA HEALTH AND LIFE | $19K | — | $19K | 2.96% |
| SEE ATTACHED3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | $202 | $12K | 26.75% |
| INSURANCE OFFICE OF AMERICA ONTARIO3 | 3281 E GUASTI RD SUITE 400 ONTARIO, CA 91761 | UNITED HEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 8.00% |
| IOA - INSURANCE OFFICE OF AMERICA3 Filed as: IOA INSURANCE SERVICES | 3281 E GUASTI RD STE 400 ONTARIO, CA 91761 | VISION SERVICE PLAN | $561 | — | $561 | 9.12% |
| INSURANCE OFFICE OF AMERICA3 | 1855 W STATE RD 434 LONGWOOD, FL 32750 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $784 | — | $784 | 14.68% |
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 | 135 | 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) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH PLAN OF NEVADA/SIERRA HEALTH AND LIFE | 162 | $646K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 141 | $37K |
| Vision | VISION SERVICE PLAN | 137 | $6K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 123 | $5K |
| Prescription drug | HEALTH PLAN OF NEVADA/SIERRA HEALTH AND LIFE | 162 | $646K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 123 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.