| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | BLUE CROSS OF CALIFORNIA | $17K | — | $17K | 4.62% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | KAISER FOUNDATION HEALTH PLAN INC | $18K | — | $18K | 5.02% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | GUARDIAN | $10K | — | $10K | 10.00% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 | P.O. BOX 5406 SAN CLEMENTE, CA 92674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $997 | — | $997 | 3.61% |
| BIJAN NOORI CORPORATION3 | 180 E. OCEAN BLVD, SUITE 650B LONG BEACH, CA 90802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $997 | — | $997 | 3.61% |
| CDR BENEFITS3 | 180 E OCEAN BLVD LONG BEACH, CA 90802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $997 | — | $997 | 3.61% |
| AARON A BLACKBURN3 | 4605 CERRITOS AVE LONG BEACH, CA 90807 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $997 | — | $997 | 3.61% |
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 | 116 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 104 | $719K |
| Dental | GUARDIAN | 257 | $97K |
| Vision | GUARDIAN | 257 | $97K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $28K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $28K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $28K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 104 | $719K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.