| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $41K | $0 | $41K | 4.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $957 | $957 | 3.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | — | DELTA DENTAL OF CALIFORNIA | $15 | $0 | $15 | 0.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD GLENDALE, CA 91203 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $787 | $0 | $787 | 8.95% |
| CHRISTA G AUFDEMBERG INC4 Filed as: CHRISTA G. AUFDEMBERG, INC. | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $2K | $0 | $2K | 33.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $406 | $0 | $406 | 8.90% |
| MARIA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $68 | $0 | $68 | 1.49% |
| SANDRA SIMS4 Filed as: SANDRA ALLEN | 501 AGUA PLACE SEAL BEACH, CA 90740 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $28 | $0 | $28 | 0.61% |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 169 | $841K |
| Dental | DELTA DENTAL OF CALIFORNIA | 18 | $11K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 177 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $26K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $26K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 169 | $841K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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.