| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN, INC. | $14K | — | $14K | 4.63% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | AETNA | $12K | — | $12K | 4.88% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMIN INC | 721 S PARKER STE 300 ORANGE, CA 92868 | AETNA | $4K | — | $4K | 1.43% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | AETNA | $9K | — | $9K | 4.61% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMIN INC | 721 S PARKER STE 300 ORANGE, CA 92868 | AETNA | $5K | — | $5K | 2.64% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $867 | — | $867 | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $434 | — | $434 | 5.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD. BLD 1, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $434 | $434 | 5.00% |
| GIS BENEFITS INC5 Filed as: GIS | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $65 | $65 | 0.75% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $578 | — | $578 | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $289 | — | $289 | 5.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLD 1, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $289 | $289 | 5.00% |
| GIS BENEFITS INC5 Filed as: GIS | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $38 | $38 | 0.66% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $552 | — | $552 | 10.01% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $276 | — | $276 | 5.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $276 | $276 | 5.00% |
| GIS BENEFITS INC5 Filed as: GIS | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $35 | $35 | 0.63% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | CALIFORNIA DENTAL NETWORK, INC. | $0 | — | $0 | 0.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $329 | — | $329 | 10.02% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $164 | — | $164 | 4.99% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD BLD 1, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $164 | $164 | 4.99% |
| GIS BENEFITS INC5 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $22 | $22 | 0.67% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $323 | — | $323 | 9.99% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $162 | — | $162 | 5.01% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD. BLD 1, SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $162 | $162 | 5.01% |
| GIS BENEFITS INC5 Filed as: GIS | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $37 | $37 | 1.14% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $86 | — | $86 | 10.06% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | $43 | — | $43 | 5.03% |
| GIS BENEFITS INC5 Filed as: GIS BENEFITS, INC. | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $7 | $7 | 0.82% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | 9401 AMBERGLEN BLVD SUITE 100 AUSTIN, TX 78729 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 60 | $758K |
| Dental(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $70K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $67K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 97 | $9K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 8 | $6K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 60 | $758K |
| Other(5 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 97 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.