| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC | $37K | $0 | $37K | 4.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $314 | $314 | 0.03% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT & INS. SVCS. LLC | 74 DISCOVERY IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN INC | $33K | $0 | $33K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON, IL 60006 | BLUE CROSS BLUE SHIELD OF ARIZONA | $12K | $1K | $13K | 3.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | UNITEDHEALTHCARE INSURANCE COMPANY | $12K | $0 | $12K | 4.08% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT & INS. SVCS. LLC | 74 DISCOVERY IRVINE, CA 92618 | UNITEDHEALTHCARE INSURANCE COMPANY | -$34 | $0 | -$34 | -0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | $8K | $22K | 12.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 1.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | $0 | $17K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON, IL 60006 | BLUE CROSS BLUE SHIELD OF ARIZONA | $4K | $0 | $4K | 4.24% |
| MJ INSURANCE3 Filed as: CHRISTOPHER TANG AND VARIOUS AGENTS | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $7K | $340 | $7K | 7.82% |
| JOY E GUNDERSON3 Filed as: JOY GUNDERSON | 4531 VALLENCITO LANE YORBA LINDA, CA 92886 | AFLAC | $5K | $224 | $5K | 5.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $5K | $0 | $5K | 5.32% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE APARTMENT E EASTVALE, CA 91752 | AFLAC | $4K | $554 | $5K | 5.00% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $2K | $224 | $2K | 2.27% |
| PATRICIA ANN BOSCH3 Filed as: PATRICIA BOSCH | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $2K | $330 | $2K | 2.13% |
| G SCOTT COOKE3 | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $2K | $0 | $2K | 1.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $3K | $0 | $3K | 10.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 | UNKNOWN GARDEN GROVE, CA 92843 | BLUE CROSS BLUE SHIELD OF TEXAS | $2K | $60 | $2K | 20.07% |
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 | 170 | 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) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.5M |
| Dental(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 203 | $350K |
| Vision | BLUE CROSS OF CALIFORNIA | 324 | $26K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 170 | $204K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 170 | $204K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 170 | $111K |
| Prescription drug(6 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.4M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 170 | $204K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.