| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CELINA MARIE COFFMAN3 Filed as: CELINA M. COFFMAN | P.O. BOX 2059 HUNTINGTON BEACH, CA 92647 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $9K | — | $9K | 5.28% |
| MARY AMEN3 | P. O. BOX 2059 HUNTINGTON BEACH, CA 92647 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 4.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 1.53% |
| COFFMAN INSURANCE AGENCY INC.3 | P. O. BOX 2059 HUNTINGTON BEACH, CA 92647 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | -$2K | — | -$2K | -1.28% |
| MARY A AMEN3 Filed as: MARY A. AMEN | 4167 WARNER AVENUE #302 HUNTINGTON BEACH, CA 92649 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 3.65% |
| CELINA MARIE COFFMAN3 | 17452 SEABURY LANE HUNTINGTON BEACH, CA 92649 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 3.65% |
| MARY A AMEN3 Filed as: MARY A. AMEN | 4167 WARNER AVENUE #302 HUNTINGTON BEACH, CA 92649 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.18% |
| CELINA MARIE COFFMAN3 | 17452 SEABURY LANE HUNTINGTON BEACH, CA 92649 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.18% |
| SWMH INSURANCE SERVICES INC.3 | 18377 BEACH BLVD. SUITE 325 HUNTINGTON BEACH, CA 92648 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 4.92% |
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 | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $165K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 153 | $146K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $165K |
| Life insurance(3 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $348K |
| Short-term disability(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 153 | $182K |
| Long-term disability(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 153 | $182K |
| Other(3 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $348K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.