| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | CALIFORNIA PHYSICIANS SERVICE | $65K | — | $65K | 5.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS SERVICE | — | $24K | $24K | 1.80% |
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | — | $22K | 6.15% |
| AMWINS3 Filed as: LISI, INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 2.50% |
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | AMERITAS LIFE INSURANCE CORP. | $11K | — | $11K | 5.63% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | AMERITAS LIFE INSURANCE CORP. | $6K | — | $6K | 2.96% |
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $800 | $4K | 18.68% |
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $205 | $3K | 16.14% |
| POMS & ASSOCIATES INSURANCE BROKERS3 | 5700 CANOGA AVE., SUITE 400 WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $771 | $234 | $1K | 13.03% |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 100 | $1.7M |
| Dental | AMERITAS LIFE INSURANCE CORP. | 127 | $190K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 127 | $190K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $29K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 30 | $18K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 100 | $1.7M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.