| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CARPENTER, MARK J3 | 1100 INDUSTRIAL RD 3 SAN CARLOS, CA 94070 | BLUE SHIELD OF CALIFORNIA | — | $95K | $95K | 3.90% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES, | LLC 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | $50K | — | $50K | 2.08% |
| AMWINS3 Filed as: LISI LLC D/B/A AMWINS CONNECT | INSURANCE SERVICES LLC 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 944023766 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $3K | $22K | 5.74% |
| MARK CARPENTER3 | 1100 INDUSTRIAL RD STE 3 SAN CARLOS, CA 940704131 | METROPOLITAN LIFE INSURANCE COMPANY | $18K | — | $18K | 4.73% |
| SHAWNA PABST3 | 4170 NEEDLES HWY NEEDLES, CA 92363 | AFLAC | $90 | — | $90 | 4.73% |
| ELIZABETH ANNE BACON3 | 29411 SW CAMELOT ST WILSONVILLE, OR 97070 | AFLAC | $51 | — | $51 | 2.68% |
| WILLIAM JAMES MCPHEE3 | 20332 SW ERIN PL ALOHA, OR 97003 | AFLAC | $50 | — | $50 | 2.63% |
| JERRY OLIVER CREECH3 | 5915 SANTO DOMINGO CT NEW BERN, NC 28560 | AFLAC | $24 | — | $24 | 1.26% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $13 | — | $13 | 0.68% |
| JUDITH M BARRY3 | 1 MICHAEL DR EAST HAMPTON, CT 06424 | AFLAC | $2 | — | $2 | 0.11% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | — | $2 | 0.11% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $2 | — | $2 | 0.11% |
| BALTOR INSURANCE SERVICES3 | 1020 MERNER RD HILLSBOROUGH, CA 94010 | AFLAC | $1 | — | $1 | 0.05% |
| JANELLE M GADOMSKI3 | 48 FAIRVIEW AVE PARK RIDGE, NJ 07656 | AFLAC | $99 | — | $99 | 5.23% |
| JOSHUA BALTOR3 | 1020 MERNER RD HILLSBOROUGH, CA 94010 | AFLAC | $65 | — | $65 | 3.43% |
| CHRISTY DAY ASSOCIATES LLC3 | 14 WALL ST STE 8C NEW YORK, NY 10005 | AFLAC | $53 | — | $53 | 2.80% |
| TREVOR FENNELL3 | 7 HIGHLAND LN EAST HAMPTON, NY 11937 | AFLAC | $26 | — | $26 | 1.37% |
| KENNETH C MEIER CORP3 | 19 MARKWOOD RD GARDEN CITY, NY 11530 | AFLAC | $11 | — | $11 | 0.58% |
| BENITO A ROTONDI II INC3 | 23 PINE RIDGE RD SARATOGA SPRINGS, NY 12866 | AFLAC | $3 | — | $3 | 0.16% |
| BRIAN WHITE3 | 6 COWDIN LN CHAPPAQUA, NY 10514 | AFLAC | $3 | — | $3 | 0.16% |
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 | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 197 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 376 | $2.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $380K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $380K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $380K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $380K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $380K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 376 | $2.4M |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 535 | $383K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 535 | — |
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.