| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 3655 NOBEL DR STE 450 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC | $58K | $41 | $58K | 1.61% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD SUITE 100 AGOURA HILLS, CA 91301 | KAISER FOUNDATION HEALTH PLAN INC | $39K | $0 | $39K | 1.08% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $48 | $0 | $48 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | BLUE CROSS OF CALIFORNIA | $30K | $0 | $30K | 1.47% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD SUITE 100 AGOURA HILLS, CA 91301 | BLUE CROSS OF CALIFORNIA | $11K | $0 | $11K | 0.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 N BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | PREMIER ACCESS INSURANCE COMPANY | $4K | $0 | $4K | 1.15% |
| HIXME INSURANCE SOLUTIONS, INC.3 | — | PREMIER ACCESS INSURANCE COMPANY | $3K | $0 | $3K | 0.97% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 2301 DUPORT DRIVE 2ND FLOOR IRVINE, CA 92612 | PREMIER ACCESS INSURANCE COMPANY | $9 | $0 | $9 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BOULEVARD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $0 | $15K | 10.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10K | $10K | 6.60% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD SUITE 100 AGOURA HILLS, CA 91301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.86% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD SUITE 100 AGOURA HILLS, CA 91301 | VISION SERVICE PLAN | $840 | $0 | $840 | 1.15% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS-PLEASE SEE ATTACHED | — | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | $0 | $5K | 9.70% |
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 | 477 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 604 | $5.7M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 915 | $358K |
| Vision | VISION SERVICE PLAN | 487 | $73K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 523 | $149K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 523 | $149K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 523 | $149K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 523 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 915 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.