| 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. | $36K | — | $36K | 5.65% |
| DAVIS LIFE INSURANCE AGENCY, INC.3 | 3110 SOUTH FIRST STREET LUFKIN, TX 75915 | BLUECROSS BLUE SHIELD OF TEXAS | $8K | $171 | $8K | 4.52% |
| FRIESEN-STRAIN INSURANCE ASSOCIATES3 | 5028 CHAMPIONS DRIVE LUFKIN, TX 75901 | BLUECROSS BLUE SHIELD OF TEXAS | $2K | — | $2K | 0.89% |
| EDWARD J. EYBSEN3 Filed as: EDWARD EYBSEN | 601 E. DAILY DRIVE, SUITE 122 CAMARILLO, CA 93010 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 5.60% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADMIN. | P.O. BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $4K | $16K | 19.02% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | — | $574 | $574 | 0.69% |
| COLLABORATIVE INSURANCE SOLUTIONS3 | 601 E. DAILY DRIVE, SUITE 122 CAMARILLO, CA 93010 | METROPOLITAN LIFE INSURANCE COMPANY | — | $274 | $274 | 0.33% |
| EDWARD J. EYBSEN3 | 751 DAILY DRIVE, SUITE 230 CAMARILL, CA 93010 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $2K | — | $2K | 3.00% |
| EDWARD J. EYBSEN3 | 751 DAILY DRIVE, SUITE 230 CAMARILLO, CA 93010 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $1K | — | $1K | 2.71% |
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 | 120 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 135 | $1.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 288 | $83K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 288 | $83K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 288 | $83K |
| Prescription drug(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 135 | $863K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 288 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.