| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 500 N. SANTA FE VISALIA, CA 93292 | CALIFORNIA PHYSICIANS' SERVICE | $30K | — | $30K | 5.33% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS' SERVICE | $17K | — | $17K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $3K | — | $3K | 0.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES OF | CALIFORNIA INSURANCE SERVICES 505 N. BRAND BLVD., SUITE 600 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC. | $23K | — | $23K | 4.91% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA DRIVE WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 2.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 1.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC. | — | $340 | $340 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | GUARDIAN | $270 | $5K | $5K | 9.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC. | 333 E. OSBOURNE ROAD SUITE 27 PHOENIX, AZ 85012 | GUARDIAN | $3K | — | $3K | 4.58% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | GUARDIAN | $1K | — | $1K | 2.14% |
| PACIFIC ADVISORS LLC3 | 333 N. INDIAN HILL BLVD. CLAREMONT, CA 91711 | GUARDIAN | $5 | — | $5 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 505 N. BRAND BLVD. GLENDALE, CA 91203 | EYEMED VISION CARE | $682 | — | $682 | 8.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICE LLC | P.O. BOX 6030 PASADENA, CA 91102 | EYEMED VISION CARE | $134 | — | $134 | 1.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 505 N. BRAND BLVD. FLOOR 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $623 | — | $623 | 7.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF RAOD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $424 | $424 | 5.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $195 | — | $195 | 2.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 505 N. BRAND BLVD. FLOOR 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $152 | — | $152 | 7.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $50 | — | $50 | 2.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $27 | $27 | 1.33% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 79 | $1.0M |
| Dental | GUARDIAN | 99 | $56K |
| Vision | EYEMED VISION CARE | 104 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $10K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 79 | $1.0M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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.