| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3838 CAMINO DEL RIO NORTH SUITE 200 SAN DIEGO, CA 92108 | UNIMERICA LIFE INSURANCE COMPANY | $46K | — | $46K | 10.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3838 CAMINO DEL RIO NORTH SUITE 200 SAN DIEGO, CA 92108 | SIMNSA | $10K | — | $10K | 7.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3838 CAMINO DEL RIO NORTH SUITE 200 SAN DIEGO, CA 92108 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 10.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSCOPE BENEFITS INC EIN 71-0847266 CLAIMS PROCESSING | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 27 CORPORATE HILL DR LITTLE ROCK, AR 72205 | $115K |
| MVI ADMINISTRATORS INSURANCE EIN 33-0393692 PLAN MANAGEMENT | Plan Administrator Service code 14 | 1011 CAMINO DEL RIO SOUTH SUITE 300 SAN DIEGO, CA 92108 | $98K |
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 CLAIMS PROCESSING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator; Other services Service code 12 | 21555 OXNARD BLVD WOODLAND HILLS, CA 91367 | $38K |
| SHEPPARD MULLIN RICHTER & HAMPTON EIN 95-1463164 ATTORNEY | Legal Service code 29 | 12275 EL CAMINO REAL SAN DIEGO, CA 92130 | $21K |
| GALLAGHER BENEFIT SERVICES INC EIN 94-3015711 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 3838 CAMINO DEL RIO NORTH 200 SAN DIEGO, CA 92108 | $5K |
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 | 220 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 220 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | SIMNSA | 207 | $149K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $34K |
| Stop-loss / reinsurancereinsurance | UNIMERICA LIFE INSURANCE COMPANY | 170 | $448K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.