| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 500 NORTH SANTA FE VISALIA, CA 93292 | CALIFORNIA PHYSICIANS SERVICE | $0 | $75K | $75K | 5.84% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS SERVICE | $27K | $0 | $27K | 2.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | $0 | $8K | 5.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 545 METRO PLACE SOUTH, SUITE 435 DUBLIN, OH 43017 | UNITED CONCORDIA INSURANCE COMPANY | $14K | $4K | $18K | 12.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | $0 | $3K | 3.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 5.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 736 SOUTH STONE AVENUE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $650 | $650 | 1.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 736 STONE AVENUE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $383 | $383 | 0.78% |
| RAMONA MARGARET DALY3 | 2877 CALLE HERALDO SAN CLEMENTE, CA 92673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $772 | $140 | $912 | 4.80% |
| HEFFERNAN INSURANCE BROKERS3 | 3734 MANOR DRIVE LAKEWOOD, CA 90712 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $778 | $0 | $778 | 4.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE IRVINE, CA 92612 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $593 | $3 | $596 | 3.14% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R&B ENROLLMENT SVS AND OTHER AGENTS | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $461 | $26 | $487 | 2.56% |
| LISA ANN MCLAUGHLIN3 | 30310 HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $205 | $0 | $205 | 1.08% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE STREET, SUITE 340 NEWPORT BEACH, CA 92660 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $68 | $104 | $172 | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3435 WILSHIRE BOULEVARD, SUITE 3000 LOS ANGELES, CA 90010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $143 | $0 | $143 | 0.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 500 NORTH BRAND BOULEVARD SUITE 100 GLENDALE, CA 91203 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 185 | $1.5M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 236 | $139K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 257 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $49K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $68K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $49K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 185 | $1.5M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.