| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $54K | $8K | $61K | 4.79% |
| VOLUNTARY BENEFIT ADVISORS3 | 1936 EAST DEERE AVENUE SANTA ANA, CA 92705 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $16K | $23K | 62.05% |
| CARLOS MENDEZ3 | 1936 EAST DEERE AVENUE SANTA ANA, CA 92705 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $5K | $8K | 20.72% |
| MJ INSURANCE3 Filed as: SEAN C. ARENS AND VARIOUS AGENTS | 20392 REDWOOD LANE HUNTINGTON BEACH, CA 92646 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $281 | $3K | 7.86% |
| ROSS PENDERGRAFT3 | 16622 CALAHAN STREET NORTH HILLS, CA 91343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 6.65% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $891 | $2K | 6.48% |
| MARIA CRISTINA MORALES TREJO3 | 1201 WALNUT AVENUE, APARTMENT 99 TUSTIN, CA 92780 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $109 | $2K | 5.56% |
| JC MEDINA CORPORATION3 | 1936 EAST DEERE AVENUE SANTA ANA, CA 92705 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET. 8TH FLOOR WOODLAND HILLS, CA 91367 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 7.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62683 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $438 | $302 | $740 | 4.38% |
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 | 321 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 288 | $1.3M |
| Dental | BLUE CROSS OF CALIFORNIA | 331 | $175K |
| Vision | BLUE CROSS OF CALIFORNIA | 331 | $175K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 331 | $192K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 288 | $1.3M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 331 | $229K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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.