| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | BLUE CROSS OF CALIFORNIA | $7K | $8K | $15K | 0.43% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTER DRIVE, SUITE 100 SAN DIEGO, CA 92122 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $880 | $86 | $966 | 23.17% |
| BB&H BENEFIT DESIGNS3 | 109 E VICTORIA STREET SANTA BARBARA, CA 93101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.31% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, JOSEPH | CUSTOM BENEFITS PROGRAMS INC. 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.12% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFITS PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTER DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $664 | $53 | $717 | 31.03% |
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 | 510 | 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) | 510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 367 | $3.5M |
| Dental | BLUE CROSS OF CALIFORNIA | 367 | $3.5M |
| Vision | EYEMED VISION CARE | 670 | $36K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 507 | $85K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 45 | $4K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 506 | $72K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 367 | $3.5M |
| Other(5 contracts, 5 carriers) | BLUE CROSS OF CALIFORNIA | 510 | $3.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 670 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.