| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT. AND INS. SVCS. | 74 DISCOVERY IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN, INC. | $32K | $0 | $32K | 4.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 0.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | BLUE CROSS BLUE SHIELD OF TEXAS | $6K | $120 | $6K | 4.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4110 NORTH SCOTTSDALE ROAD SUITE 250 SCOTTSDALE, AZ 85260 | BLUE CROSS BLUE SHIELD OF ARIZONA | $1K | $0 | $1K | 1.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 15.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 333 EAST OSBORN ROAD, SUITE 270 PHOENIX, AZ 85012 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $508 | $3K | 11.89% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $305 | $0 | $305 | 4.33% |
| MJ INSURANCE3 Filed as: DAVID STEINBERG AND VARIOUS AGENTS | 425 CATALPA AVENUE BREA, CA 92821 | AFLAC | $140 | $0 | $140 | 1.99% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, CA 33334 | AFLAC | $82 | $0 | $82 | 1.16% |
| KEVIN J MARKEL3 Filed as: KEVIN J. MARKEL | 1410 ROANOKE STREET LA HABRA, CA 90631 | AFLAC | $37 | $0 | $37 | 0.52% |
| ROBERT G. CANSECO3 | 13603 EDGEFIELD STREET CERRITOS, CA 90703 | AFLAC | $30 | $0 | $30 | 0.43% |
| NICHOLAS E VIGIL3 Filed as: NICHOLAS R. D'ERRICO | 1745 WEST ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | AFLAC | $27 | $0 | $27 | 0.38% |
| JESSICA RENEE GREENE3 Filed as: JESSICA R. GREENE | 714 WILLIAMS DRIVE, SUITE B HUNTINGTON BEACH, CA 92648 | AFLAC | $19 | $0 | $19 | 0.27% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT. AND INS. SVCS. | 74 DISCOVERY IRVINE, CA 92618 | AMERITAS LIFE INSURANCE CORPORATION | $461 | $0 | $461 | 10.01% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $99 | $0 | $99 | 2.29% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $78 | $0 | $78 | 1.80% |
| SCOTT W BLACKSHEAR AND OTHER AGENTS3 | 108 ALSACE COURT PONTE VEDRA BEACH, FL 32082 | AFLAC | $47 | $0 | $47 | 1.09% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON, JR. | 5520 WILSHIRE BOULEVARD, SUITE 727 LOS ANGELES, CA 90036 | AFLAC | $37 | $0 | $37 | 0.86% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $32 | $0 | $32 | 0.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $31 | $0 | $31 | 0.72% |
| JONATHAN ALI HAJIMOMEN3 | 6540 GRAND MANAN DRIVE CYPRESS, CA 90630 | AFLAC | $20 | $0 | $20 | 0.46% |
| SHARON MCKELVEY3 Filed as: SHARON I. MCKELVEY | 589 EAST CONESTOGA CIRCLE GRAND JUNCTION, CO 81504 | AFLAC | $48 | $0 | $48 | 3.13% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $35 | $0 | $35 | 2.28% |
| GLEN DOUGLAS GABLE3 | 3521 SOUTH CAMELLIA PLACE CHANDLER, AZ 85248 | AFLAC | $26 | $0 | $26 | 1.69% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $24 | $0 | $24 | 1.56% |
| RICHARD K. FORCONI AND OTHER AGENTS3 | 5065 EAST MAZATZAL DRIVE CAVE CREEK, AZ 85331 | AFLAC | $24 | $0 | $24 | 1.56% |
| NATALIE MALHAM3 | 5822 NORTH 13TH STREET PHOENIX, AZ 85014 | AFLAC | $12 | $0 | $12 | 0.78% |
| SCOTT WEBB3 | 26729 NORTH 91ST DRIVE PEORIA, AZ 85383 | AFLAC | $7 | $0 | $7 | 0.46% |
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 | 59 | 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) | 59 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 87 | $1.0M |
| Dental(5 contracts, 3 carriers) | DELTA DENTAL OF CALIFORNIA | 99 | $105K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 37 | $32K |
| Life insurance(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 18 | $47K |
| Short-term disability(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 18 | $47K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 18 | $34K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 87 | $999K |
| Other(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 18 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
No prospect flags tripped on this filing.