| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $84K | — | $84K | 3.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 3.64% |
| DINORAH ROSSANA DEVALLY0 | 361 MISTY TRAILS PLACE SIMI VALLEY, CA 93065 | AFLAC | $2K | $397 | $2K | 6.23% |
| NASHINA BUSH3 | 16161 VENTURA BOULEVARD, SUITE 421 ENCINO, CA 91436 | AFLAC | $2K | $108 | $2K | 4.89% |
| VICTOR NORDENFLYCHT-DARBY3 Filed as: VICTOR NORDENFLYCHT DARBY | 2459 NORTH BRIGHTON STREET BURBANK, CA 91504 | AFLAC | $1K | $492 | $2K | 4.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2393 TOWNSGATE ROAD, SUITE 101 WESTLAKE VILLAGE, CA 91361 | AFLAC | $1K | $58 | $2K | 3.97% |
| BRIAN G JAEGGI3 Filed as: BRIAN G. JAEGGI | 5700 CHICOPEE AVENUE ENCINO, CA 91316 | AFLAC | $1K | $198 | $1K | 3.32% |
| MJ INSURANCE3 Filed as: RENEE CORSO AND VARIOUS AGENTS | 5805 SEPULVEDA BOULEVARD, SUITE 740 SHERMAN OAKS, CA 91411 | AFLAC | $904 | $202 | $1K | 2.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91411 | AFLAC | $884 | — | $884 | 2.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | VISION SERVICE PLAN | $1K | — | $1K | 5.00% |
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 | 213 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 397 | $2.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 367 | $201K |
| Vision | VISION SERVICE PLAN | 160 | $21K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 397 | $2.2M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 397 | $2.2M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 397 | $2.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 397 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 397 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.