| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER - IRVINE | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | KAISER FOUNDATION HEALTH PLAN INC. | — | $746 | $746 | 0.01% |
| HOGAN INSURANCE SERVICES, INC.3 Filed as: HOGAN INSURANCE SERVICES INC | PO BOX 7419 THOUSAND OKAS, CA 91359 | RELIANCE STANDARD | — | $89 | $89 | 0.23% |
| 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 | $242K |
| HUB INTERNATIONAL INSURANCE SERVICE EIN 33-0315047 BROKER | Insurance agents and brokers Service code 22 | 4695 MACARTHUR COURT SUITE 600 NEWPORT BEACH, CA 92626 | $124K |
| ARTHUR J GALLAGHER & CO EIN 94-3015711 BROKER | Insurance agents and brokers; Consulting (general) Service code 16 | 21820 BURBANK BLVD SUITE 175 WOODLAND HILLS, CA 913676486 | $84K |
| CRYSTAL IBC LLC EIN 47-2002720 BROKER | Insurance agents and brokers Service code 22 | WALL STREET STATION PO BOX 1405 NEW YORK, NY 10268 | $49K |
| LAQUER, URBAN, CLIFFORD & HODGE LLP EIN 95-4047729 ATTORNEY | Legal Service code 29 | 225 S LAKE AVE SUITE 200 PASADENA, CA 91101 | $39K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 BROKER | Insurance agents and brokers; Consulting (general) Service code 16 | PO BOX 632886 CINCINNATI, OH 452632886 | $28K |
| 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 | $27K |
| 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 | 2,012 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,014 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 841 | $6.9M |
| Dental | GUARDIAN | 739 | $338K |
| Vision | VISION SERVICE PLAN | 521 | $45K |
| Life insurance | RELIANCE STANDARD | 246 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 841 | — |
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 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.