| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BENEFIT COMMERCE GROUP, LLC | 14300 NORTH NORTHSIGHT BOULEVARD SUITE 221 SCOTTSDALE, AZ 85260 | BLUE CROSS BLUE SHIELD OF ARIZONA | $47K | $0 | $47K | 4.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC | $41K | $0 | $41K | 3.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $4K | $4K | 0.40% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT & INS. SVCS. LLC | 74 DISCOVERY IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN INC | $36K | $0 | $36K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVNEUE, SUITE 200 IRVINE, CA 92612 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $0 | $4K | 1.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $19K | $8K | $27K | 14.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | $6K | $25K | 19.86% |
| CASSANDRA JOHNSON AND OTHER AGENTS3 | 1745 EAST OCEAN BOULEVARD APARTMENT 8 LONG BEACH, CA 90802 | AFLAC | $6K | $302 | $6K | 6.10% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE APARTMENT E EASTVALE, CA 91752 | AFLAC | $5K | $328 | $5K | 5.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $5K | $0 | $5K | 4.73% |
| JOY E GUNDERSON3 Filed as: JOY GUNDERSON | 4531 VALLENCITO LANE YORBA LINDA, CA 92886 | AFLAC | $5K | $84 | $5K | 4.52% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $2K | $84 | $2K | 1.95% |
| CHRISTOPHER L. TANG3 Filed as: CHRISTOPHER TANG | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $1K | $0 | $1K | 1.29% |
| G SCOTT COOKE3 | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $1K | $0 | $1K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | BLUE CROSS BLUE SHIELD OF ARIZONA | $2K | $0 | $2K | 2.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $1K | $125 | $1K | 5.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4100 NEWPORT PLACE DRIVE, SUITE 650 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $1K | $0 | $1K | 4.27% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MGMT & INS. SVCS. LLC | 74 DISCOVERY IRVINE, CA 92618 | AMERITAS LIFE INSURANCE CORP. | $164 | $0 | $164 | 9.97% |
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 | 171 | 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) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 5 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 264 | $3.4M |
| Dental(4 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 201 | $371K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 320 | $29K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 171 | $231K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 171 | $231K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 171 | $127K |
| Prescription drug(6 contracts, 4 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 264 | $3.3M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 171 | $231K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.