| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD J. EYBSEN3 Filed as: EDWARD EYBSEN | 601 E. DAILY DRIVE, SUITE 122 CAMARILLO, CA 93010 | KAISER FOUNDATION HEALTH PLAN INC. | $55K | — | $55K | 7.06% |
| DAVIS LIFE INSURANCE AGENCY, INC.3 | 3110 SOUTH FIRST STREET LUFKIN, TX 75915 | BLUECROSS BLUE SHIELD OF TEXAS | $8K | $216 | $8K | 4.50% |
| FRIESEN-STRAIN INSURANCE ASSOCIATES3 | 5028 CHAMPIONS DRIVE LUFKIN, TX 75901 | BLUECROSS BLUE SHIELD OF TEXAS | $2K | $720 | $3K | 1.70% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN. | P.O. BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $20K | $5K | $25K | 24.49% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 3.78% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | SAFEGUARD HEALTH PLANS, INC. | — | $290 | $290 | 4.51% |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 184 | $953K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 230 | $108K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 230 | $102K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 230 | $102K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 184 | $776K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 230 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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.