| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | KAISER FOUNDATION HEALTH PLAN INC. | $56K | — | $56K | 5.08% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 0.48% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | HEALTH NET | $20K | — | $20K | 5.69% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 777 S. FIGUEROA STREET LOS ANGELES, CA 90017 | HEALTH NET | $5K | — | $5K | 1.31% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | KAISER FOUNDATION HEALTH PLAN INC. | $16K | — | $16K | 4.56% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 0.43% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | UNION SECURITY INSURANCE COMPANY | $12K | — | $12K | 7.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNION SECURITY INSURANCE COMPANY | — | $8K | $8K | 4.60% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 3560 LENOX ROAD ATLANTA, GA 30326 | UNION SECURITY INSURANCE COMPANY | $4K | — | $4K | 2.50% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | NIPPON LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 3.89% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | P.O. BOX 9465 NEW YORK, NY 10087 | NIPPON LIFE INSURANCE COMPANY OF AMERICA | $499 | — | $499 | 0.59% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | UDC DENTAL OF CALIFORNIA, INC. | $916 | — | $916 | 7.33% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 3560 LENOX ROAD ATLANTA, GA 30326 | UDC DENTAL OF CALIFORNIA, INC. | $334 | — | $334 | 2.67% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $1K | — | $1K | 11.62% |
| TADASHI KIMURA3 | 4900 N. GRAND AVENUE COVINA, CA 91724 | PACIFIC GUARDIAN LIFE INSURANCE COMPANY | $922 | — | $922 | 8.22% |
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 | 177 | 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) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 271 | $1.9M |
| Dental(3 contracts, 3 carriers) | UNION SECURITY INSURANCE COMPANY | 112 | $262K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 177 | $23K |
| Short-term disability | AFLAC | 20 | $12K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 271 | $1.4M |
| Other(2 contracts, 2 carriers) | AFLAC | 177 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.