| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MANAGEMENT & INS SVCS | 74 DISCOVERY IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN INC | $38K | $0 | $38K | 4.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC | $4K | $1 | $4K | 0.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 333 EAST OSBORN ROAD, SUITE 270 PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | $3K | $0 | $3K | 2.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | BLUE CROSS BLUE SHIELD OF TEXAS | $3K | $75 | $3K | 4.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 333 EAST OSBORN ROAD, SUITE 270 PHOENIX, AZ 85012 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $3K | $6K | 17.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $7K | 20.50% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $105 | $0 | $105 | 2.34% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $83 | $0 | $83 | 1.85% |
| J. A. HAJIMOMEN & OTHER AGENTS3 | 6540 GRAND MANAN DRIVE CYPRESS, CA 90630 | AFLAC | $45 | $0 | $45 | 1.00% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $40 | $0 | $40 | 0.89% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON, JR. | 5520 WILSHIRE BOULEVARD APARTMENT 727 LOS ANGELES, CA 90036 | AFLAC | $37 | $0 | $37 | 0.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $31 | $0 | $31 | 0.69% |
| SHARI BOYCE3 | 4953 SOUTH JORDAN AVENUE ONTARIO, CA 91762 | AFLAC | $21 | $0 | $21 | 0.47% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SPECTRUM RISK MANAGEMENT & INS SVCS | 74 DISCOVERY IRVINE, CA 92618 | AMERITAS LIFE INSURANCE CORPORATION | $340 | $0 | $340 | 9.99% |
| SHARON MCKELVEY3 Filed as: SHARON I. MCKELVEY | 197 NORTH NOTTINGHAM LANE LOT 3 PAYSON, AZ 85541 | AFLAC | $64 | $0 | $64 | 3.13% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $47 | $0 | $47 | 2.30% |
| SCOTT WEBB3 Filed as: SCOTT WEBB & OTHER AGENTS | 26729 NORTH 91ST DRIVE PEORIA, AZ 85383 | AFLAC | $35 | $0 | $35 | 1.71% |
| GLEN DOUGLAS GABLE3 | 3521 SOUTH CAMELLIA PLACE CHANDLER, AZ 85248 | AFLAC | $34 | $0 | $34 | 1.66% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $32 | $0 | $32 | 1.56% |
| NATALIE MALHAM3 | 5822 NORTH 13TH STREET PHOENIX, AZ 85014 | AFLAC | $16 | $0 | $16 | 0.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $6 | $0 | $6 | 0.29% |
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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 133 | $988K |
| Dental(4 contracts, 3 carriers) | DELTA DENTAL OF CALIFORNIA | 119 | $110K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 44 | $37K |
| Life insurance(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $40K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $40K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $33K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 133 | $981K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 123 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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.