| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | BLUE CROSS OF CALIFORNIA | $39K | $0 | $39K | 2.71% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | BLUE CROSS OF CALIFORNIA | $14K | $4K | $17K | 1.18% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMINISTRATORS INC | 721 SOUTH PARKER STREEET ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | $0 | $7K | $7K | 0.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5HT FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $0 | $6K | 4.19% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | PO BOX 85638 SAN DIEGO, CA 92186 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 1.42% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $640 | $640 | 0.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | SUN LIFE ASSURANCE COMPANY OF CANADA | $328 | $0 | $328 | 0.23% |
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 | 289 | 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) | 289 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 245 | $1.5M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 194 | $145K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 194 | $145K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 245 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.