| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 SMITH RANCH ROAD, SUITE 112 SAN RAFAEL, CA 94903 | CALIFORNIA PHYSICIANS' SERVICE | $21K | $2K | $23K | 5.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 6.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | KAISER FOUNDATION HEALTH PLAN INC | — | $40 | $40 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN INC | -$4K | — | -$4K | -1.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | UNION SECURITY INSURANCE COMPANY | $3K | $885 | $4K | 6.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 700 BROADWAY DENVER, CO 80273 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $6K | — | $6K | 17.80% |
| HEINZ SCHULMEISTER3 | 2663 CENTINELA AVENUE, UNIT 202 SANTA MONICA, CA 90405 | AFLAC | $4K | $228 | $4K | 13.95% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 12121 WILSHIRE BOULEVARD SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $826 | $45 | $871 | 3.06% |
| MJ INSURANCE3 Filed as: JANELLE ZAMORA AND VARIOUS AGENTS | 421 WEST BROADWAY, SUITE 4157 LONG BEACH, CA 90802 | AFLAC | $420 | — | $420 | 1.47% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR. | 11620 WILSHIRE BOULEVARD, SUITE 210 SANTA MONICA, CA 90403 | AFLAC | $298 | — | $298 | 1.05% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 1502 BROADWAY, SUITE 308 SANTA MONICA, CA 90404 | AFLAC | $184 | $46 | $230 | 0.81% |
| JOSEPH L. AGAGON3 | 421 WEST BROADWAY LONG BEACH, CA 90802 | AFLAC | $176 | — | $176 | 0.62% |
| STEVEN R. JOHNSON3 Filed as: STEVEN R JOHNSON | 3848 WEST CARSON STREET, SUITE 110 TORRANCE, CA 90503 | AFLAC | $150 | — | $150 | 0.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 700 BROADWAY DENVER, CO 80273 | ANTHEM LIFE INSURANCE COMPANY | $3K | — | $3K | 17.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD GLENDALE, CA 91102 | EYEMED | $1K | — | $1K | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | UDC DENTAL OF CALIFORNIA, INC. | $1K | $85 | $1K | 19.85% |
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 | 96 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 96 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 78 | $772K |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 68 | $67K |
| Vision | EYEMED | 130 | $14K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 96 | $35K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 96 | $15K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 78 | $772K |
| Other(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 96 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.