| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FULLERTON INSURANCE SERVICES I3 Filed as: FULLERTON INSURANCE SERVICE,INC. | PO BOX 4054 FULLERTON, CA 928344054 | KAISER FOUNDATION HEALTH PLAN INC | $39K | — | $39K | 4.33% |
| FULLERTON INSURANCE SERVICE IN3 | 1009 S PLACENTIA AVE FULLERTON, CA 92831 | BLUE SHIELD OF CLAIFORNIA | $26K | — | $26K | 4.00% |
| AMWINS3 Filed as: LISI, INC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE SHIELD OF CLAIFORNIA | — | $13K | $13K | 2.00% |
| FULLERTON INSURANCE SERVICES I3 Filed as: FULLERTON INSURANCE SERVICE, INC. | PO BOX 4054 FULLERTON, CA 92834 | PREMIER ACCESS INSURANCE COMPANY | $5K | — | $5K | 7.30% |
| AMWINS3 Filed as: LISI, INC | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | PREMIER ACCESS INSURANCE COMPANY | $3K | — | $3K | 4.56% |
| FULLERTON INSURANCE SERVICES I3 | PO BOX 4054 FULLERTON, CA 92834 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 15.00% |
| FULLERTON INSURANCE SERVICES I3 Filed as: FULLERTON INSURANCE SERVICES INC | PO BOX 4054 FULLERTON, CA 92834 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 9.13% |
| FULLERTON INSURANCE SERVICES I3 Filed as: FULLERTON INSURANCE SERVICE | PO BOX 4054 FULLERTON, CA 928344054 | VSP | $2K | — | $2K | 10.00% |
| FULLERTON INSURANCE SERVICES I3 | PO BOX 4054 FULLERTON, CA 92834 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.00% |
| FULLERTON INSURANCE SERVICES I3 | PO BOX 4054 FULLERTON, CA 92834 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
| FULLERTON INSURANCE SERVICES I3 | PO BOX 4054 FULLERTON, CA 92834 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $964 | — | $964 | 10.00% |
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 | 220 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 177 | $1.5M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 262 | $73K |
| Vision | VSP | 121 | $19K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 218 | $67K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 30 | $10K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $19K |
| Prescription drug | BLUE SHIELD OF CLAIFORNIA | 162 | $645K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 218 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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.