| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC | $194K | — | $194K | 3.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $117K | — | $117K | 4.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $53K | — | $53K | 9.00% |
| MJ INSURANCE3 Filed as: LILY YAN AND VARIOUS AGENTS | 5805 SEPULVEDA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $2K | — | $2K | 3.24% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS. SERVICES | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | AFLAC | $1K | — | $1K | 1.87% |
| CHARLES EDWARD WILLIAMS3 | 847 NORTH HOLLYWOOD WAY, SUITE 204 BURBANK, CA 91505 | AFLAC | $989 | — | $989 | 1.66% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVENUE STUDIO CITY, CA 91602 | AFLAC | $940 | — | $940 | 1.58% |
| SCOTT WILLIAMS3 | 840 LARRABEE STREET WEST HOLLYWOOD, CA 90069 | AFLAC | $573 | — | $573 | 0.96% |
| NOEMI OSUNA3 | 6720 CASE AVENUE NORTH HOLLYWOOD, CA 91606 | AFLAC | $372 | — | $372 | 0.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | AFLAC | $320 | — | $320 | 0.54% |
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 | 1,044 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,051 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,640 | $7.9M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 1,640 | $3.0M |
| Vision | BLUE CROSS OF CALIFORNIA | 1,640 | $2.4M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 1,640 | $2.4M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 1,640 | $2.4M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,640 | $7.9M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 1,640 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,640 | — |
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.