| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK CARPENTER3 Filed as: MARK J CARPENTER | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $48K | $2K | $50K | 17.93% |
| AMWINS Filed as: LISI INC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $19K | $19K | 6.88% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD #3 SAN CARLOS, CA 94404 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES (CIGNA) | $14K | — | $14K | 9.93% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES (CIGNA) | — | $5K | $5K | 3.45% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD #3 SAN CARLOS, CA 94070 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $594 | $3K | 12.78% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 5.00% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD #3 SAN CARLOS, CA 94070 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $445 | $2K | 12.78% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $801 | $801 | 5.00% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD #3 SAN CARLOS, CA 94070 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $395 | $2K | 12.68% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $736 | $736 | 5.00% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD #3 SAN CARLOS, CA 94070 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $359 | $99 | $458 | 12.77% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $179 | $179 | 4.99% |
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 | 139 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 124 | $278K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES (CIGNA) | 111 | $139K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES (CIGNA) | 111 | $139K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $15K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $16K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.