| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| QSR INSURANCE AGENCY INC.3 | 18607 VENTURA BLVD. STE 208 TARZANA, CA 91356 | BLUE SHIELD OF CALIFORNIA | $40K | — | $40K | 5.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INC SERVICE | 32110 AGOURA RD. WESTLAKE VILLAGE, CA 91361 | BLUE SHIELD OF CALIFORNIA | $15K | — | $15K | 1.88% |
| QSR INSURANCE AGENCY INC.3 Filed as: QSR INSURANCE AGENCY | PO BOX 570245 TARZANA, CA 91357 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 4.72% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 2110 AGOURA RD. WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 2.29% |
| QSR INSURANCE AGENCY INC.3 Filed as: QSR INSURANCE | PO BOX 0570245 TARZANA, CA 91357 | HUMANA INSURANCE COMPANY | $22K | — | $22K | 15.84% |
| ENROLLEASE3 | 660 YORK ST. STE 102 SAN FRANCISCO, CA 94110 | HUMANA INSURANCE COMPANY | $1K | — | $1K | 1.05% |
| QSR INSURANCE AGENCY INC.3 | PO BOX 0570245 TARZANA, CA 91357 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 15.00% |
| QSR INSURANCE AGENCY INC.3 Filed as: QSR INSURANCE AGENCY | PO BOX 0570245 TARZANA, CA 91357 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
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 | 123 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 118 | $1.2M |
| Dental | HUMANA INSURANCE COMPANY | 102 | $138K |
| Vision | HUMANA INSURANCE COMPANY | 102 | $138K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $48K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $48K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $48K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 118 | $790K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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.