| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | BLUE CROSS OF CALIFORNIA | $162K | — | $162K | 4.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $12 | $13K | 7.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 101 LARKSPUR LANDING CIRCLE SUITE 120 LARKSPUR, CA 94939 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 2.26% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INSURANCE | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA DENTAL NETWORK, INC. | $3K | — | $3K | 8.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER AND CO INSURANCE | 16130 VENTURA BOULEVARD, SUITE 400 ENCINO, CA 91436 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 20.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $238 | $238 | 2.40% |
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 | 627 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 633 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 640 | $3.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 346 | $221K |
| Vision | BLUE CROSS OF CALIFORNIA | 640 | $3.7M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 640 | $3.7M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 11 | $10K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 11 | $10K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 640 | $3.7M |
| Other | BLUE CROSS OF CALIFORNIA | 640 | $3.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.