| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 21011 WARNER CENTER LANE WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $85K | $0 | $85K | 4.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $408 | $408 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $6K | $0 | $6K | 7.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | BLUE CROSS OF CALIFORNIA | $639 | $0 | $639 | 0.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE ALMADEN BOULEVARD, SUITE 960 SAN JOSE, CA 95113 | HUMANADENTAL INSURANCE COMPANY | $8K | $0 | $8K | 9.97% |
| ANNETTE L. BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $2K | $85 | $2K | 5.44% |
| MJ INSURANCE3 Filed as: RUSSELL LAKE JR. AND VARIOUS AGENTS | 29309 BEACHCOMBER DRIVE SUN CITY, CA 92585 | AFLAC | $2K | $154 | $2K | 4.87% |
| JAIME PUERTA3 Filed as: JAIME I. PUERTA | 28443 SANTA CATARINA ROAD SANTA CLARITA, CA 91350 | AFLAC | $423 | $0 | $423 | 1.08% |
| JACOB BURNS INC.3 Filed as: JACOB BURNS, INC. | 11637 GORHAM AVENUE, APARTMENT 106 LOS ANGELES, CA 90049 | AFLAC | $414 | $0 | $414 | 1.06% |
| MARIA ISABEL TORRES3 | 16154 CANTLAY STREET VAN NUYS, CA 91406 | AFLAC | $401 | $0 | $401 | 1.02% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $172 | $0 | $172 | 0.44% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | THREE MITCHELL PLACE, UNIT 18C NEW YORK, NY 10017 | AFLAC | $171 | $0 | $171 | 0.44% |
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 | 181 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 304 | $1.8M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 370 | $164K |
| Vision | BLUE CROSS OF CALIFORNIA | 370 | $83K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 304 | $1.8M |
| Other | AFLAC | 66 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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.