| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2 PIERCE PL THE GALLAGHER CENTRE ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN, INC. | $16K | — | $16K | 3.90% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION INSURANCE SERVICES, INC. | 80 S. LAKE AVENUE, #600 PASADENA, CA 911014970 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | — | $5K | 1.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2 PIERCE PL THE GALLAGHER CENTRE ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 3.62% |
| ASCENSION BENEFITS & INS. SOLUTIONS3 Filed as: ASCENSION INSWURANCE SERVICES, INC. | 80 S. LAKE AVENUE, #600 PASADENA, CA 911014970 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | — | $1K | 1.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 45 E. RIVER PARK PLACE W, #605 FRESNO, CA 937201565 | HUMANA | $3K | — | $3K | 6.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | SAN FRANCISCO 2 PIERCE PL FL #14 ITASCA, IL 601431203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $873 | — | $873 | 7.26% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION INSURANCE SERVICES, INC. | 80 S. LAKE AVENUE, #600 PASADENA, CA 911014970 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $330 | — | $330 | 2.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 45 E. RIVER PARK PLACE W, #605 FRESNO, CA 93720 | EYEMED VISION CARE / FIDELITY SECURITY LIFE INSURANCE COMPANY | $645 | — | $645 | 7.49% |
| PORTAL INSURANCE AGENCY, INC.3 Filed as: PORTAL INSURANCE | 1277 TREAT BLVD., #400 WALNUT CREEK, CA 94597 | EYEMED VISION CARE / FIDELITY SECURITY LIFE INSURANCE COMPANY | $154 | — | $154 | 1.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFUIT SERVICES, INC. | SAN FRANCISCO 2 PIERCE PL FL #14 ITASCA, IL 601431203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $384 | — | $384 | 5.23% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION INSURANCE SERVICES, INC. | 80 S. LAKE AVENUE, #600 PASADENA, CA 911014970 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $130 | — | $130 | 1.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 | SAN FRANCISCO 2 PIERCE PL FL 14 ITASCA, IL 601431203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $175 | — | $175 | 5.27% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION INSURANCE SERVICES, INC. | 80 S. LAKE AVENUE, #600 PASADENA, CA 911014970 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $58 | — | $58 | 1.75% |
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 | 101 | 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) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 78 | $481K |
| Dental | HUMANA | 74 | $50K |
| Vision | EYEMED VISION CARE / FIDELITY SECURITY LIFE INSURANCE COMPANY | 91 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $3K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $7K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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.