| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDMONDS INSURANCE SERVICES, INC.3 Filed as: EDMONDS INSURANCE SERVICES INC. | 126 LOMITA STREET EL SEGUNDO, CA 90245 | KAISER FOUNDATION HEALTH PLAN | $16K | $0 | $16K | 4.07% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN | $8K | $0 | $8K | 2.17% |
| VERED JUSTIN3 | 17061 EMPANADA PLACE ENCINO, CA 91436 | KAISER FOUNDATION HEALTH PLAN | $5K | $0 | $5K | 1.36% |
| EDMONDS INSURANCE SERVICES, INC.3 Filed as: EDMONDS INSURANCE SERVICES INC. | 126 LOMITA STREET EL SEGUNDO, CA 90245 | HEALTH NET | $17K | $0 | $17K | 5.24% |
| VERED JUSTIN3 | 17061 EMPANADA PLACE ENCINO, CA 91436 | HEALTH NET | $6K | $0 | $6K | 1.75% |
| EDMONDS INSURANCE SERVICES, INC.3 Filed as: EDMONDS INSURANCE SERVICES INC. | 126 LOMITA STREET EL SEGUNDO, CA 90245 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.53% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET #800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $4K | $4K | 4.08% |
| VERED JUSTIN3 | 17061 EMPANADA PLACE ENCINO, CA 91436 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.51% |
| GARY ALFRED JOHNSON3 | 6709 LA TIJERA BOULEVARD, PMB 926 LOS ANGELES, CA 90045 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9K | $23 | $9K | 11.12% |
| VERED JUSTIN3 | 17061 EMPANADA PLACE ENCINO, CA 91436 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $0 | $5K | 5.52% |
| JACK ALLEN NORRIS3 Filed as: JACK WU | 821 BURLINGTON STREET FILLMORE, CA 93015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $291 | $0 | $291 | 0.34% |
| QILIN-INDIO3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $212 | $4 | $216 | 0.26% |
| NICHOLAS RYAN DERRICO3 | 1745 WEST ORANGEWOOD AVENUE #212 ORANGE, CA 92868 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $212 | $1 | $213 | 0.25% |
| RUTH CRUZ3 | 1733 SOUTH MIRAMONTE AVENUE ONTARIO, CA 91761 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $4 | $30 | 0.04% |
| ABRAMS MARKETING INC3 Filed as: ABRAMS MARKETING, INC. | 9538 WEST PICO BOULEVARD #204 LOS ANGELES, CA 90035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.02% |
| TERI ROLLIN3 | C/O TERI ROLLIN OAK PARK, CA 91377 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
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 | 157 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 81 | $708K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $110K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $110K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $110K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 57 | $85K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 57 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.