| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KCAL HEALTH INSURANCE SERVICES3 | 2148 S HACIENDA BLVD HACIENDA HEIGHT, CA 91745 | BLUE CROSS OF CALIFORNIA | $14K | — | $14K | 1.72% |
| KCAL HEALTH INSURANCE SERVICES3 | 2148 S HACIENDA BLVD HACIENDA HEIGHTS, CA 91745 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 0.99% |
| AMWINS3 Filed as: LISI INC | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 0.57% |
| AMWINS3 Filed as: LISI INC | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 0.33% |
| GLOBAL CITIZENS INSURANCE AGCY3 | — | DELTA DENTAL OF CALIFORNIA | $17K | — | $17K | 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 | 195 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | 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) | BLUE CROSS OF CALIFORNIA | 262 | $826K |
| Dental | DELTA DENTAL OF CALIFORNIA | 315 | $167K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 315 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.