| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC | $33K | $5K | $38K | 5.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 5.00% |
| RUSSEL G. LAKE JR.3 | 29309 BEACHCOMBER DRIVE SUN CITY, CA 92585 | AFLAC | $436 | — | $436 | 3.84% |
| ELIZABETH SHARON AND OTHER AGENTS3 | 612 SOUTH BARRINGTON AVENUE SUITE 312 LOS ANGELES, CA 90049 | AFLAC | $379 | — | $379 | 3.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | AFLAC | $333 | — | $333 | 2.93% |
| WILLIAM ANDREWS3 Filed as: WILLIAM M ANDREWS | 22122 SHERMAN WAY, SUITE 309 CANOGA PARK, CA 91303 | AFLAC | $304 | — | $304 | 2.68% |
| MJR INSURANCE SERVICES LLC3 | 7349 PONCE AVENUE WEST HILLS, CA 91307 | AFLAC | $263 | — | $263 | 2.32% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVENUE STUDIO CITY, CA 91602 | AFLAC | $263 | — | $263 | 2.32% |
| SCOTT ALEXANDER3 | 11940 WEDDINGTON STREET, SUITE 2 VALLEY VILLAGE, CA 91607 | AFLAC | $196 | — | $196 | 1.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | EYEMED VISION CARE | $868 | — | $868 | 9.16% |
| CHRISTA G AUFDEMBERG INC4 Filed as: CHRISTA G. AUFDEMBERG, INC. | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $833 | — | $833 | 11.24% |
| PATRICIA SWANSON4 | 579 WEST LEMON AVENUE MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $540 | — | $540 | 7.28% |
| MARIA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $263 | — | $263 | 3.55% |
| LESLIE WILMER4 | 11702 SOUTH LAUREL DRIVE, APT. 3A LAUREL, MD 20708 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $53 | — | $53 | 0.71% |
| MJ INSURANCE4 Filed as: KYLE M. STAFFORD AND VARIOUS AGENTS | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $46 | — | $46 | 0.62% |
| GABRIELE MARIA CEIDEBURG4 | 10181 LOOKOUT BRIDGE STREET LAS VEGAS, NV 89183 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $36 | — | $36 | 0.49% |
| DEREK BRANDON4 | 203 WEST VERNON AVENUE LOS ANGELES, CA 90037 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $34 | — | $34 | 0.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $257 | $91 | $348 | 13.55% |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 174 | $729K |
| Dental | DELTA DENTAL OF CALIFORNIA | 198 | $35K |
| Vision | EYEMED VISION CARE | 177 | $9K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 110 | $3K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 174 | $729K |
| Other(3 contracts, 3 carriers) | AFLAC | 110 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.