| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $200K | $0 | $200K | 3.56% |
| UNKNOWN3 | UNKNOWN CHATSWORTH, CA 91311 | HOLMAN FAMILY COUNSELING, INC. | $1K | $0 | $1K | 9.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $1K | $0 | $1K | 10.00% |
| MJ INSURANCE3 Filed as: GAY M. HUNDLEY AND VARIOUS AGENTS | 8796 FOREST CREEK LANE ANNA, TX 75409 | AFLAC | $469 | $0 | $469 | 4.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $166 | $0 | $166 | 1.56% |
| PATRICIA LUSCOMBE ZAPF3 | 669 SERENITY COURT GRAND JUNCTION, CO 81505 | AFLAC | $116 | $0 | $116 | 1.09% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $107 | $0 | $107 | 1.00% |
| RICKIE D. HALL3 | 2628 NORTH CAPECOD WAY MERIDIAN, ID 83646 | AFLAC | $90 | $0 | $90 | 0.84% |
| BRUCE W. FORD3 | PO BOX 5734 KENT, WA 98064 | AFLAC | $56 | $0 | $56 | 0.53% |
| CLAUDIA L FELDMAN3 Filed as: CLAUDIA L. FELDMAN | 9037 EAST CASITAS DEL RIO DRIVE SCOTTSDALE, AZ 85255 | AFLAC | $51 | $0 | $51 | 0.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $240 | $0 | $240 | 9.99% |
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 | 1,179 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 18 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 871 | $5.6M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 871 | $5.6M |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 871 | $5.6M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 871 | $5.6M |
| Short-term disability | AFLAC | 13 | $11K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 871 | $5.6M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,179 | $5.6M |
| 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.