| 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 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $41K | — | $41K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3838 CAMINO DEL RIO NORTH SUITE 200 SAN DIEGO, CA 92108 | SIMNSA | $11K | — | $11K | 7.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3838 CAMINO DEL RIO NORTH SUITE 200 SAN DIEGO, CA 92108 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP LLC EIN 77-0385729 CLAIMS PROCESSING | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | PO BOX 45018 FRESNO, CA 93721 | $124K |
| MVI ADMINISTRATORS INSURANCE EIN 33-0393692 PLAN MANAGEMENT | Plan Administrator Service code 14 | 1011 CAMINO DEL RIO SOUTH SUITE 300 SAN DIEGO, CA 92108 | $106K |
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 CLAIMS PROCESSING | Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | 21555 OXNARD BLVD WOODLAND HILLS, CA 91367 | $51K |
| BEESON, HOFFMAN & SIDDALL INC EIN 95-3654092 PLAN AUDITOR | Accounting (including auditing) Service code 10 | 500 NORTH CENTRAL AVENUE SUITE 325 GLENDALE, CA 91203 | $19K |
| 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 | $8K |
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 | 198 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SIMNSA | 200 | $163K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $11K |
| Stop-loss / reinsurancereinsurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 168 | $407K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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.