| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES OF LA | 21820 BURBANK BLVD., SUITE 300 WOODLAND HILLS, CA 91367 | HEALTH NET | $27K | — | $27K | 5.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 6.40% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES OF LA | 21820 BURBANK BLVD., SUITE 300 WOODLAND HILLS, CA 91367 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 3.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $946 | — | $946 | 6.39% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES OF LA | 21820 BURBANK BLVD., SUITE 300 WOODLAND HILLS, CA 91367 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $535 | — | $535 | 3.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | STANDARD INSURANCE COMPANY | $358 | $80 | $438 | 9.56% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES OF LA | 21820 BURBANK BLVD SUITE 300 WOODLAND HILLS, CA 91367 | STANDARD INSURANCE COMPANY | $103 | — | $103 | 2.25% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES OF LA | 21820 BURBANK BLVD SUITE 300 WOODLAND HILLS, CA 91367 | ANTHEM LIFE INSURANCE COMPANY | $105 | — | $105 | 10.31% |
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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 237 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 75 | $539K |
| Dental | BLUE CROSS OF CALIFORNIA | 174 | $84K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 144 | $15K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 235 | $6K |
| Prescription drug | HEALTH NET | 75 | $539K |
| Other(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 235 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.