| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDMONDS INSURANCE SERVICES, INC.3 | 126 LOMITA STREET EL SEGUNDO, CA 90245 | BLUE SHIELD OF CALIFORNIA | $45K | $0 | $45K | 4.65% |
| DAVID J DIMARIA3 Filed as: DAVID J. DIMARIA | 130 NORTH BRAND BLVD., SUITE 310 GLENDALE, CA 91203 | BLUE SHIELD OF CALIFORNIA | $28K | $0 | $28K | 2.96% |
| EDMONDS INSURANCE SERVICES, INC.3 | 126 LOMITA STREET EL SEGUNDO, CA 90245 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | $0 | $8K | 5.06% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | $0 | $3K | 1.51% |
| EDMONDS INSURANCE SERVICES, INC.3 | 126 LOMITA STREET EL SEGUNDO, CA 90245 | UNITEDHEALTHCARE INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. - CA | 669 RIVER DR. CENTER II, SUITE 305 ELMWOOD PARK, NJ 07407 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 5.00% |
| EDMONDS INSURANCE SERVICES, INC.3 | 126 LOMITA STREET EL SEGUNDO, CA 90245 | HOLMAN PROFESSIONAL COUNSELING CENTERS | $147 | $0 | $147 | 5.02% |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 85 | $1.1M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 110 | $61K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 110 | $61K |
| Other | HOLMAN PROFESSIONAL COUNSELING CENTERS | 110 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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.