| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOZANI INSURANCE SERVICES3 | 4540 KEARNY VILLA RD STE 112 SAN DIEGO, CA 92123 | KAISER FOUNDATION HEALTH PLAN INC | $12K | — | $12K | 7.03% |
| LOZANI INSURANCE SERVICES3 | 4540 KEARNY VILLA RD STE 112 SAN DIEGO, CA 92123 | HUMANADENTAL INSURANCE COMPANY | $4K | — | $4K | 3.34% |
| LOZANI INSURANCE SERVICES3 Filed as: LOZANI, AMIR H | 4540 KEARNY VILLA RD STE 112 SAN DIEGO, CA 92123 | HUMANA INSURANCE COMPANY | $7K | — | $7K | 12.45% |
| LOZANI INSURANCE SERVICES3 Filed as: LOZANI INSURANCE SERVICES, INC | 4540 KEARNY VILLA ROAD SUITE 1 SAN DIEGO, CA 92123 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 14.47% |
| AMIR LOZANI3 | 810 W PENNSYLVANIA AVE. SAN DIEGO, CA 92103 | HMAA HAWAII MEDICAL ASSURANCE ASSOCIATION | $596 | — | $596 | 2.84% |
| LOZANI INSURANCE SERVICES3 Filed as: LOZANI, AMIR H | 4540 KEARNY VILLA RD SAN DIEGO, CA 92123 | KANAWHA INSURANCE COMPANY | $3K | — | $3K | 15.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $91K |
| AMIR LOZANI BROKER | Other commissions Service code 55 | 4540 KEAMY VILLA ROAD SUITE 112 SAN DIEGO, CA 92123 | $42K |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 11 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 49 | $209K |
| Dental | HUMANADENTAL INSURANCE COMPANY | 173 | $110K |
| Vision | HUMANA INSURANCE COMPANY | 479 | $56K |
| Life insurance(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 479 | $74K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 67 | $45K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 67 | $45K |
| Prescription drug | HMAA HAWAII MEDICAL ASSURANCE ASSOCIATION | 6 | $21K |
| Other(3 contracts, 3 carriers) | HUMANADENTAL INSURANCE COMPANY | 479 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 479 | — |
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.