| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT BENEFITS INSURANCE OF SO CA | 1820 E 1ST STREET SUITE 500 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | — | $22K | 0.52% |
| LEAVITT GROUP3 Filed as: LEAVITT SO CAL INSURANCE SERVICES | 1820 E 1ST STREET SUITE 500 SANTA ANA, CA 92705 | VISION SERVICE PLAN | $2K | — | $2K | 3.38% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452362886 | RELIANCE STANDARD | — | $2K | $2K | 5.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MVI ADMINISTRATORS, INC. EIN 33-0393692 ADMINISTRATOR | Plan Administrator Service code 14 | 1011 CAMINO DEL RIO SOUTH STE 300 SAN DIEGO, CA 92108 | $249K |
| LEAVITT INS SERVICES OF S CA, INC EIN 11-3714867 BROKER | Insurance agents and brokers Service code 22 | 1820 E FIRST ST STE 500 SANTA ANA, CA 92705 | $205K |
| MELISSA W. COOK & ASSOCIATES EIN 95-3245809 ATTORNEY | Legal Service code 29 | 3444 CAMINO DEL RIO SOUTH SUITE 106 SAN DIEGO, CA 92108 | $32K |
| ARTHUR J GALLAGHER & CO EIN 94-3015711 BROKER | Insurance agents and brokers Service code 22 | 21011 WARNER CENTER LANE WOODLAND HILLS, CA 91367 | $29K |
| INSURANCE OFFICE OF AMERICA, INC. EIN 59-2472656 BROKER | Insurance agents and brokers Service code 22 | 3281 E GUASTI ROAD STE 400 ONTARIO, CA 91761 | $22K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 BROKER | Insurance agents and brokers Service code 22 | PO BOX 632886 CINCINNATI, OH 452632886 | $22K |
| CRYSTAL IBC LLC EIN 47-2002720 BROKER | Insurance agents and brokers Service code 22 | WALL STREET STATION PO BOX 1405 NEW YORK, NY 10268 | $13K |
| LEAF & COLE, LLP EIN 95-2076568 AUDITOR | Accounting (including auditing) Service code 10 | 2810 CAMINO DEL RIO SOUTH SUITE 200 SAN DIEGO, CA 92108 | $12K |
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 | 1,653 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,658 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 746 | $6.8M |
| Dental | GUARDIAN | 756 | $321K |
| Vision | VISION SERVICE PLAN | 672 | $63K |
| Life insurance | RELIANCE STANDARD | 192 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 756 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.