| 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 | $59K | — | $59K | 3.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURNACE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $17K | — | $17K | 9.17% |
| VOLUNTARY BENEFIT ADVISORS3 | 1936 EAST DEERE AVENUE SANTA ANA, CA 92705 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 10.40% |
| CARLOS MENDEZ3 | 1936 EAST DEERE AVENUE, SUITE 215 SANTA ANA, CA 92705 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $563 | $1K | $2K | 5.02% |
| ROSS PENDERGRAFT3 | 16622 CALAHAN STREET NORTH HILLS, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $898 | — | $898 | 2.51% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $576 | $160 | $736 | 2.06% |
| MJ INSURANCE3 Filed as: SEAN C. ARENS AND VARIOUS AGENTS | 20392 REDWOOD LANE HUNTINGTON BEACH, CA 92646 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $496 | $37 | $533 | 1.49% |
| MARIA CRISTINA MORALES TREJO3 | 1201 WALNUT AVENUE, APARTMENT 99 TUSTIN, CA 92780 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $380 | $12 | $392 | 1.09% |
| JC MEDINA CORPORATION3 Filed as: J.C. MEDINA CORPORATION | 201 WEST MACARTHUR BOULEVARD SANTA ANA, CA 92707 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $332 | $38 | $370 | 1.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $350 | $2K | 11.88% |
| CLEMENCIA SALAMATAMOLI3 | 5620 YOLANDA AVENUE, SUITE 120 TARZANA, CA 91356 | AFLAC | $417 | — | $417 | 2.26% |
| MJ INSURANCE3 Filed as: ADRIAN GONZALEZ AND VARIOUS AGENTS | 5805 SEPULVEDA BOULEVARD, SUITE 740 SHERMAN OAKS, CA 91411 | AFLAC | $390 | — | $390 | 2.11% |
| JANET KATHRYN IRWIN3 | 6305 SOUTH HALF MOON DRIVE APARTMENT A BAKERSFIELD, CA 93309 | AFLAC | $380 | — | $380 | 2.06% |
| LORRAINE C. MABBETT3 | PO BOX 5211 WEST HILLS, CA 91308 | AFLAC | $380 | — | $380 | 2.06% |
| RICHARD J KUNZ3 Filed as: RICHARD J. KUNZ | 351 CALIFORNIA STREET, SUITE 450 SAN FRANCISCO, CA 94104 | AFLAC | $295 | — | $295 | 1.60% |
| PAUL GALLEGOS3 | 10519 SHOSHONE AVENUE GRANADA HILLS, CA 91344 | AFLAC | $179 | — | $179 | 0.97% |
| AUBREY W THOMAS3 Filed as: AUBREY W. THOMAS | 32627 THE OLD ROAD CASTAIC, CA 91384 | AFLAC | $178 | — | $178 | 0.96% |
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 | 304 | 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) | 304 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 277 | $1.6M |
| Dental | BLUE CROSS OF CALIFORNIA | 318 | $186K |
| Vision | BLUE CROSS OF CALIFORNIA | 318 | $186K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 318 | $205K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 277 | $1.6M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 318 | $259K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.