| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | US FIRE INSURANCE COMPANY | $45K | — | $45K | 14.13% |
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | GUARDIAN | $4K | — | $4K | 11.44% |
| GEORGE PETERSEN INSURANCE3 | P.O BOX 3539 SANTA ROSA, CA 95402 | VISION SERVICE PLAN | $1K | — | $1K | 4.66% |
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | VISION SERVICE PLAN | $77 | — | $77 | 0.25% |
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 12.10% |
| K-KICS3 | 1612 W. OLIVE AVE., SUITE 302 BURBANK, CA 91506 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $296 | — | $296 | 14.99% |
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 | 201 | 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) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 159 | $30K |
| Life insurance(3 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 201 | $27K |
| Short-term disability | GUARDIAN | 190 | $39K |
| Long-term disability | GUARDIAN | 190 | $39K |
| Stop-loss / reinsurancereinsurance | US FIRE INSURANCE COMPANY | 162 | $317K |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 201 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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.