| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CARPENTER, MARK J3 | 1100 INDUSTRIAL RD 3 SAN CARLOS, CA 94070 | BLUE SHIELD OF CALIFORNIA | — | $108K | $108K | 5.26% |
| AMWINS3 Filed as: LISI, INC | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | $43K | — | $43K | 2.11% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD STE 3 SAN CARLOS, CA 940704131 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | $3K | $20K | 5.86% |
| AMWINS3 Filed as: LISI INSURANCE SERVICES INC | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 944023768 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | $62 | $17K | 4.94% |
| CORI SHAI HABER3 | 14 WALL ST STE 8C NEW YORK, NY 10005 | AFLAC | $396 | — | $396 | 10.48% |
| JOSHUA BALTOR3 | 185 GRAMERCY DR SAN MATEO, CA 94402 | AFLAC | $335 | — | $335 | 8.86% |
| JANELLE M GADOMSKI3 | 166 MIDLAND AVE YONKERS, NY 10705 | AFLAC | $83 | — | $83 | 2.20% |
| CHRISTY DAY ASSOCIATES LLC3 | 14 WALL ST STE 8C NEW YORK, NY 10005 | AFLAC | $53 | — | $53 | 1.40% |
| KEITH LEPACK3 | 1991 BROADWAY NEW YORK, NY 10023 | AFLAC | $41 | — | $41 | 1.08% |
| PATRICK RUHLE3 Filed as: PATRICK C HARDIE | 14 WALL ST STE 8C NEW YORK, NY 10005 | AFLAC | $35 | — | $35 | 0.93% |
| TREVOR FENNELL3 | 11835 QUEENS BLVD STE 1403 FOREST HILLS, NY 11375 | AFLAC | $26 | — | $26 | 0.69% |
| JANELLE M GADOMSKI3 | 48 FAIRVIEW AVE PARK RIDGE, NJ 07656 | AFLAC | $17 | — | $17 | 0.45% |
| KENNETH C MEIER CORP3 | 401 FRANKLIN AVE STE 312 GARDEN CITY, NY 11530 | AFLAC | $11 | — | $11 | 0.29% |
| BENITO A ROTONDI II INC3 | 23 PINE RIDGE RD SARATOGA SPRINGS, NY 12866 | AFLAC | $3 | — | $3 | 0.08% |
| BRIAN WHITE3 | 6 COWDIN LN CHAPPAQUA, NY 10514 | AFLAC | $3 | — | $3 | 0.08% |
| BALTOR INSURANCE SERVICES3 | 11 AIRPORT BLVD STE 105 SOUTH SAN FRANCISCO, CA 94080 | AFLAC | $155 | — | $155 | 4.87% |
| MARK CARPENTER3 Filed as: MARK J CARPENTER | 1100 INDUSTRIAL RD STE 3 SAN CARLOS, CA 94070 | AFLAC | $106 | — | $106 | 3.33% |
| JUDITH M BARRY3 | 1 MICHAEL DR EAST HAMPTON, CT 06424 | AFLAC | $102 | — | $102 | 3.21% |
| SHAWNA PABST3 | 21370 SW LANGER FARMS PKWY STE 142 SHERWOOD, OR 97140 | AFLAC | $98 | — | $98 | 3.08% |
| BALTOR INSURANCE SERVICES3 | 165 GRAMERCY DR SAN MATEO, CA 94402 | AFLAC | $92 | — | $92 | 2.89% |
| ELIZABETH ANNE BACON3 | 29669 SW YOUNG WAY WILSONVILLE, OR 97070 | AFLAC | $55 | — | $55 | 1.73% |
| WILLIAM JAMES MCPHEE3 | 20332 SW ERIN PL ALOHA, OR 97003 | AFLAC | $54 | — | $54 | 1.70% |
| KRISTINA J KUNZ3 | 118 GRANVILLE WAY SAN FRANCISCO, CA 94127 | AFLAC | $47 | — | $47 | 1.48% |
| JERRY OLIVER CREECH3 | 5915 SANTO DOMINGO CT NEW BERN, NC 28560 | AFLAC | $25 | — | $25 | 0.79% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $15 | — | $15 | 0.47% |
| CHRISTOPHER S AUSTERMANN3 | 148 EASTERN BLVD GLASTONBURY, CT 06033 | AFLAC | $13 | — | $13 | 0.41% |
| JENNIFER L GLANN3 | 62 NEWELL HILL RD ELLINGTON, CT 06029 | AFLAC | $10 | — | $10 | 0.31% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | — | $2 | 0.06% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $2 | — | $2 | 0.06% |
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 | 178 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 344 | $2.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $340K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $340K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $343K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $340K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $340K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 344 | $2.1M |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 484 | $347K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 484 | — |
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.