| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER, SARENA | 21021 VENTURA BLVD #200 WOODLAND HILLS, CA 91364 | BLUE CROSS OF CALIFORNIA | $10K | — | $10K | 2.80% |
| UNLIMITED LIFE INSURANCE SOLUTIONS3 | 21021 VENTURA BLVD SUITE 200 WOODLAND HILLS, CA 91364 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 2.42% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES L | 2677 N. MAIN STREET SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | — | $7K | $7K | 2.04% |
| UNLIMITED LIFE INSURANCE SOLUTIONS3 | 16255 VENTURA BLVD STE 320 ENCINO, CA 91436 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | $743 | $8K | 3.31% |
| SARENA WARNER3 | 21021 VENTURA BLVD STE 200 WOODLAND HILLS, CA 91364 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 1.61% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES, | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 1.55% |
| UNLIMITED LIFE INSURANCE SOLUTIONS3 | 21021 VENTURA BLVD STE 200 WOODLAND HILLS, CA 91364 | PRINCIPAL LIFE INSURANCE COMPANY | $17K | — | $17K | 9.18% |
| SARENA WARNER3 Filed as: SARENA GRACE WARNER | 21021 VENTURA BLVD STE 200 WOODLAND HILLS, CA 91364 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 4.95% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | PRINCIPAL LIFE INSURANCE COMPANY | — | $8K | $8K | 4.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD UNIT 100 PASADENA, CA 91107 | PRINCIPAL LIFE INSURANCE COMPANY | -$433 | — | -$433 | -0.24% |
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 | 124 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 42 | $577K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $180K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $180K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $180K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $180K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $180K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.