| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | KAISER FOUNDATION HEALTH PLAN INC | — | $13K | $13K | 0.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | KAISER FOUNDATION HEALTH PLAN INC | — | $6K | $6K | 0.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MVI ADMINISTRATORS, INC. EIN 33-0393692 ADMINISTRATOR | Plan Administrator Service code 14 | 2615 CAMINO DEL RIO SOUTH SUITE 201 SAN DIEGO, CA 92108 | $362K |
| VENBROOK INSURANCE SERVICES EIN 01-0709538 BROKER/CONSULTANT | Consulting (general); Insurance agents and brokers Service code 16 | 6320 CANOGA AVE 12TH FLOOR WOODLAND HILLS, CA 91367 | $239K |
| HUB INTERNATIONAL INSURANCE SERVICE EIN 33-0315047 BROKER | Insurance agents and brokers Service code 22 | 4695 MACARTHUR COURT STE 600 NEWPORT BEACH, CA 92626 | $87K |
| 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 | $78K |
| LAQUER, URBAN, CLIFFORD & HODGE LLP EIN 95-4047729 ATTORNEY | Legal Service code 29 | 200 SOUTH LOS ROBLES AVE SUITE 500 STE 200 PASADENA, CA 91101 | $48K |
| ALLIANT INSURANCE SERVICES, INC. EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | 701 B STREET 6TH FLOOR SAN DIEGO, CA 92101 | $20K |
| RBTK, LLP EIN 33-0567239 INDEPENDENT AUDITOR | Direct payment from the plan Service code 50 | 5675 RUFFIN ROAD SUITE 300 SAN DIEGO, CA 92123 | $19K |
| ARTHUR J GALLAGHER & CO EIN 94-3015711 CONSULTANT | Consulting (general) Service code 16 | 21820 BURBANK BLVD SUITE 175 WOODLAND HILLS, CA 913676486 | $0 |
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 | 1,586 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,591 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 862 | $8.8M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 806 | $319K |
| Vision | VISION SERVICE PLAN | 591 | $47K |
| Other(3 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 252 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 862 | — |
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.