| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN INC | $29K | — | $29K | 4.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13K | — | $13K | 20.74% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $995 | $4K | 6.35% |
| MJ INSURANCE3 Filed as: SUSAN G. STOKES AND VARIOUS AGENTS | 3113 WEST 187TH PLACE TORRANCE, CA 90504 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $406 | $4K | 6.12% |
| LUIS ERNESTO PEREZ3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $368 | $3K | 4.84% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $904 | $3K | 4.84% |
| GABRIEL HOLGUIN3 | 26342 FOREST BRIDGE DRIVE LAKE FOREST, CA 92630 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $348 | $2K | 3.72% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $462 | $2K | 2.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2030 MAIN STREET, SUITE 200 IRVINE, CA 92614 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 9.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2030 MAIN STREET, SUITE 200 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $2K | — | $2K | 10.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2030 MAIN STREET, SUITE 200 IRVINE, CA 92614 | VISION SERVICE PLAN | $769 | — | $769 | 7.40% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 149 | $688K |
| Dental(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 106 | $44K |
| Vision | VISION SERVICE PLAN | 89 | $10K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 149 | $688K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 96 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.
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.