| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE CLERK3 | 1055 E. COLORADO BLVD. PASADENA, CA 91106 | KAISER FOUNDATION HEALTH PLAN INC. | $27K | — | $27K | 3.01% |
| JERROLD SMITH3 | 1840 CENTURY PARK LOS ANGELES, CA 90067 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 2.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 1.10% |
| INSURANCE CLERK3 | 1055 E. COLORADO BLVD. PASADENA, CA 91106 | CALIFORNIA PHYSICIANS SERVICE | — | $16K | $16K | 2.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | CALIFORNIA PHYSICIANS SERVICE | — | $10K | $10K | 1.74% |
| JERROLD SMITH3 | 11835 W OLYMPIC BLVD. LOS ANGELES, CA 90067 | CALIFORNIA PHYSICIANS SERVICE | — | $10K | $10K | 1.74% |
| INSURANCE OFFICE OF AMERICA3 | 1885 W STATE ROAD LONGWOOD, FL 32750 | HUMANA, INC. | $16K | — | $16K | 10.17% |
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 | 199 | 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) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 111 | $1.5M |
| Dental | HUMANA, INC. | 199 | $153K |
| Vision | HUMANA, INC. | 199 | $153K |
| Life insurance | HUMANA, INC. | 199 | $153K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 111 | $1.5M |
| Other | HUMANA, INC. | 199 | $153K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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.