| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALEX FERNANDEZ D/B/A AXIS INSURANCE3 Filed as: ALEX FERNANDEZ | PO BOX 4064 HUNTINGTON BEACH, CA 926054064 | KAISER FOUNDATION HEALTH PLAN, INC. | $70K | — | $70K | 6.96% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES, | INC. 32110 AGOURA RD WESTLAKE VILLAGE, CA 913614026 | KAISER FOUNDATION HEALTH PLAN, INC. | $17K | — | $17K | 1.70% |
| ALEX THOR FERNANDEZ DBA AXIS3 | INSURANCE AGENCY 8464 EL ARROYO DRIVE HUNTINGTON BEACH, CA 92647 | HEALTH NET | $15K | — | $15K | 11.64% |
| TABELLO INS SERVICES INC3 | 1461 SIERRA VISTA DR LA HABRA, CA 90631 | AFLAC | $2K | $96 | $2K | 4.46% |
| JONATHAN ALI HAJIMOMEN3 | 5752 WHISTLER CIR HUNTINGTON BEACH, CA 92649 | AFLAC | $579 | $22 | $601 | 1.59% |
| DANIEL J TABELLO3 | 16330 HEATHFIELD DR WHITTIER, CA 90603 | AFLAC | $545 | — | $545 | 1.44% |
| AURELIO VELA3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $282 | — | $282 | 0.74% |
| ELENA MARIA VIERA3 | 10619 PLANETT AVE DOWNEY, CA 90241 | AFLAC | $275 | — | $275 | 0.73% |
| MARIA R. QUINTANA3 Filed as: MARIA R QUINTANA | 911 S WEBSTER AVE APT 7 ANAHEIM, CA 92804 | AFLAC | $68 | $22 | $90 | 0.24% |
| TOAN HUU PHAM3 | 546 S HARBOR BLVD SANTA ANA, CA 92704 | AFLAC | $4 | — | $4 | 0.01% |
| OLIVER SCHACK3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $4 | — | $4 | 0.01% |
| ALEX FERNANDEZ D/B/A AXIS INSURANCE3 | AGENCY PO BOX 4064 HUNTINGTON BEACH, CA 926054064 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $1K | — | $1K | 9.85% |
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 | 152 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 142 | $1.1M |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $283K |
| Vision(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $269K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $179K |
| Short-term disability | AFLAC | 41 | $38K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 270 | $179K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.