| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MANAGEMENT | 74 DISCOVERY IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN INC | $41K | $0 | $41K | 2.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE SUITE 200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC | $39K | $0 | $39K | 2.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $4K | $4K | 0.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $838 | $838 | 0.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE SUITE 200 IRVINE, CA 92612 | UNITEDHEALTHCARE INSURANCE COMPANY | $780 | $0 | $780 | 0.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | BLUE CROSS BLUE SHIELD OF ARIZONA | $7K | $0 | $7K | 3.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 369 SOUTH ARIZONA AVENUE, SUITE A CHANDLER, AZ 85225 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $6K | $18K | 14.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE SUITE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $1K | $12K | 16.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE SUITE 200 IRVINE, CA 92612 | BLUE CROSS BLUE SHIELD OF TEXAS | $1K | $105 | $2K | 3.54% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $1K | $17 | $1K | 4.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $932 | $0 | $932 | 3.75% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN AND OTHER AGENTS | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $760 | $9 | $769 | 3.09% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $627 | $0 | $627 | 2.52% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $356 | $44 | $400 | 1.61% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $262 | $0 | $262 | 1.05% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $199 | $0 | $199 | 0.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | BLUE CROSS OF CALIFORNIA | $2K | $182 | $2K | 10.86% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $1K | $0 | $1K | 6.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $854 | $0 | $854 | 5.18% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE AND OTHER AGENTS | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $771 | $0 | $771 | 4.68% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $294 | $0 | $294 | 1.78% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $276 | $0 | $276 | 1.67% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $275 | $0 | $275 | 1.67% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $245 | $0 | $245 | 1.49% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $327 | $0 | $327 | 2.97% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $300 | $0 | $300 | 2.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $220 | $0 | $220 | 2.00% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $209 | $0 | $209 | 1.90% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $183 | $0 | $183 | 1.66% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $180 | $0 | $180 | 1.64% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN AND OTHER AGENTS | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $176 | $0 | $176 | 1.60% |
| SHARI BOYCE3 Filed as: SHARI BOYCE AND OTHER AGENTS | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $489 | $0 | $489 | 5.18% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $124 | $0 | $124 | 1.31% |
| LISA K ARELLANO3 Filed as: LISA K. ARELLANO | 2982 SAN FERNANDO STREET MINDEN, NV 89423 | AFLAC | $102 | $0 | $102 | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $87 | $0 | $87 | 0.92% |
| SHARON MCKELVEY3 Filed as: SHARON I. MCKELVEY | 197 NORTH NOTTINGHAM LANE, LOT 3 PAYSON, AZ 85541 | AFLAC | $80 | $0 | $80 | 0.85% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $78 | $0 | $78 | 0.83% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $78 | $0 | $78 | 0.83% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $220 | $45 | $265 | 3.25% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $222 | $0 | $222 | 2.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $206 | $0 | $206 | 2.52% |
| DERECK ANTHONY NICHOLSON3 | 9082 EAST CEDAR BASIN LANE GOLD CANYON, AZ 85118 | AFLAC | $91 | $63 | $154 | 1.89% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE AND OTHER AGENTS | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $126 | $6 | $132 | 1.62% |
| JONATHAN ALI HAJIMOMEN3 | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $84 | $12 | $96 | 1.18% |
| LISA TAYLOR3 Filed as: LISA RENE TAYLOR | 3311 WEST LINCOLN AVENUE APARTMENT 5 ANAHEIM, CA 92801 | AFLAC | $48 | $0 | $48 | 0.59% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $494 | $22 | $516 | 9.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $430 | $0 | $430 | 7.94% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $326 | $0 | $326 | 6.02% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $139 | $0 | $139 | 2.57% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $86 | $0 | $86 | 1.59% |
| JONATHAN ALI HAJIMOMEN3 | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $44 | $0 | $44 | 0.81% |
| VICKI LYNN TIMMINS3 Filed as: VICKI LYNN TIMMINS AND OTHER AGENTS | 2303 EAST BALL ROAD, APARTMENT 211 ANAHEIM, CA 92806 | AFLAC | $36 | $0 | $36 | 0.66% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $224 | $0 | $224 | 4.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $215 | $0 | $215 | 4.16% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON AND OTHER AGENTS | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $171 | $0 | $171 | 3.31% |
| VICKI LYNN TIMMINS3 | 2303 EAST BALL ROAD, APARTMENT 211 ANAHEIM, CA 92806 | AFLAC | $164 | $0 | $164 | 3.18% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $143 | $0 | $143 | 2.77% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $82 | $0 | $82 | 1.59% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $74 | $0 | $74 | 1.43% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $304 | $0 | $304 | 9.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $208 | $0 | $208 | 6.20% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN AND OTHER AGENTS | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $99 | $0 | $99 | 2.95% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $77 | $0 | $77 | 2.29% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $66 | $0 | $66 | 1.97% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $51 | $0 | $51 | 1.52% |
| NANETTE STARK3 | 5805 SEPULVEDA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $34 | $0 | $34 | 1.01% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MANAGEMENT | 74 DISCOVERY IRVINE, CA 92618 | AMERITAS LIFE INSURANCE CORP. | $299 | $0 | $299 | 10.00% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $73 | $17 | $90 | 4.77% |
| SHANNON SCHEPPERS-GILL3 | 18570 PINECONE LANE RIVERSIDE, CA 92504 | AFLAC | $80 | $0 | $80 | 4.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $79 | $0 | $79 | 4.18% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE AND OTHER AGENTS | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $40 | $6 | $46 | 2.44% |
| NICKI LYN ALBRIGHT3 | 965 CATALINA AVENUE SEAL BEACH, CA 90740 | AFLAC | $23 | $17 | $40 | 2.12% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $36 | $0 | $36 | 1.91% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $20 | $0 | $20 | 1.06% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE, APARTMENT E EASTVALE, CA 91752 | AFLAC | $80 | — | $80 | 4.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $72 | $0 | $72 | 4.43% |
| VICKI LYNN TIMMINS3 | 2303 EAST BALL ROAD, APARTMENT 211 ANAHEIM, CA 92806 | AFLAC | $70 | $0 | $70 | 4.30% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $63 | $0 | $63 | 3.87% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $28 | $0 | $28 | 1.72% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $14 | $0 | $14 | 0.86% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC AND OTHER AGENT | 2211 MICHELSON DRIVE, SUITE 1150 IRVINE, CA 92612 | AFLAC | $12 | $0 | $12 | 0.74% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 190 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 330 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(14 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 318 | $2.4M |
| Dental(12 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $287K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 219 | $24K |
| Life insurance(11 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 134 | $162K |
| Short-term disability(11 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 134 | $162K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 134 | $75K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 318 | $2.3M |
| Other(11 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 134 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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."
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.