| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 1000 EAST WARRENVILLE ROAD SUITE 230 NAPERVILLE, IN 60563 | BLUE CROSS OF CALIFORNIA | $199K | $5K | $204K | 3.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE SUITE 200 IRVINE, CA 92612 | HOLMAN FAMILY COUNSELING, INC. | $1K | $0 | $1K | 5.44% |
| MJ INSURANCE3 Filed as: GAY M. HUNDLEY AND VARIOUS AGENTS | 620 TAYLOR TRAIL MURPHY, TX 75094 | AFLAC | $591 | $0 | $591 | 4.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $224 | $0 | $224 | 1.56% |
| PATRICIA LUSCOMBE ZAPF3 | 669 SERENITY COURT GRAND JUNCTION, CO 81505 | AFLAC | $153 | $0 | $153 | 1.07% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $135 | $0 | $135 | 0.94% |
| BRUCE W. FORD3 | PO BOX 5734 KENT, WA 98064 | AFLAC | $134 | $0 | $134 | 0.93% |
| WILLIAM A GRAHAM COMPANY3 Filed as: WILLIAM C. COVINGTON | 2340 EAST TRINITY MILLS ROAD SUITE 300 CARROLLTON, TX 75006 | AFLAC | $114 | $0 | $114 | 0.79% |
| RICKIE D. HALL3 | 2628 NORTH CAPECOD WAY MERIDIAN, ID 83646 | AFLAC | $90 | $0 | $90 | 0.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $917 | $0 | $917 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $542 | $0 | $542 | 9.28% |
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 | 789 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 21 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 818 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 927 | $5.6M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 927 | $5.6M |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 927 | $5.6M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 927 | $5.6M |
| Short-term disability | AFLAC | 17 | $14K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 927 | $5.6M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,179 | $5.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,179 | — |
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.