| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $142K | $0 | $142K | 3.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $18K | $0 | $18K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 21ST FLOOR ARLINGTON HEIGHTS, IL 60006 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $593 | $10K | 10.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 4.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 221 WEST 6TH STREET AUSTIN, TX 78701 | MANAGED HEALTH NETWORK | $692 | $0 | $692 | 5.00% |
| CHARLES EDWARD WILLIAMS3 Filed as: CHARLES E. WILLIAMS | 847 NORTH HOLLYWOOD WAY, SUITE 204 BURBANK, CA 91505 | CONTINENTAL AMERICAN INSURANCE COMPANY | $226 | $0 | $226 | 3.83% |
| BARBARA S. BARNETT3 | 847 NORTH HOLLYWOOD WAY, SUITE 204 BURBANK, CA 91505 | CONTINENTAL AMERICAN INSURANCE COMPANY | $176 | $0 | $176 | 2.98% |
| LABAN M. SPALDING3 | 4297 KLUME AVENUE STUDIO CITY, CA 91602 | CONTINENTAL AMERICAN INSURANCE COMPANY | $101 | $0 | $101 | 1.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | CONTINENTAL AMERICAN INSURANCE COMPANY | $84 | $0 | $84 | 1.42% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | CONTINENTAL AMERICAN INSURANCE COMPANY | $55 | $0 | $55 | 0.93% |
| CHRISTOPHER HAGER3 | 8201 PARK HILL DRIVE LOS ANGELES, CA 90045 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | $0 | $16 | 0.27% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 595 ELM STREET WINNETKA, IL 60093 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | $0 | $16 | 0.27% |
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 | 394 | 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) | 394 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 643 | $3.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 398 | $361K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 531 | $29K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 484 | $91K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 643 | $3.6M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 484 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 643 | — |
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.