| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KCAL HEALTH INSURANCE SERVICES3 | 2148 S. HACIENDA BLVD. HACIENDA HIGHTS, CA 91745 | BLUE CROSS OF CALIFORNIA | $63K | $97 | $63K | 4.18% |
| SHOMER INSURANCE AGENCY3 | 5805 SEPULVEDA BLVD. SHERMAN OAKS, CA 91411 | BLUE CROSS OF CALIFORNIA | $18K | — | $18K | 1.17% |
| AMWINS3 Filed as: LISI, INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | — | $17K | $17K | 1.15% |
| KCAL HEALTH INSURANCE SERVICES3 | 2148 S. HACIENDA BLVD. HACIENDA HIGHTS, CA 91745 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 3.22% |
| SHOMER INSURANCE AGENCY3 | 5805 SEPULVEDA BLVD. SHERMAN OAKS, CA 91411 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 1.67% |
| KCAL HEALTH INSURANCE SERVICES3 | 2148 S. HACIENDA BLVD. HACIENDA HIGHTS, CA 91745 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $7K | $11K | 7.29% |
| SHOMER INSURANCE AGENCY3 | 5805 SEPULVEDA BLVD. SHERMAN OAKS, CA 91411 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $118 | — | $118 | 0.08% |
| VARIOUS - SEE ATTACHED3 Filed as: CONTINENTAL AMERICAN INSURANCE | P.O. BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $222 | — | $222 | 7.53% |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 292 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 224 | $1.7M |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $146K |
| Vision | BLUE CROSS OF CALIFORNIA | 224 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 288 | $74K |
| Short-term disability | CONTINENTAL AMERICAN INSURANCE COMPANY | 17 | $3K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 224 | $1.7M |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 288 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.