| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $33K | — | $33K | 4.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND AVENUE, SUITE 600 GLENDALE, CA 91203 | UDC DENTAL OF CALIFORNIA, INC. | $2K | — | $2K | 8.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND AVENUE, SUITE 600 GLENDALE, CA 91203 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | EYEMED VISION CARE | $1K | — | $1K | 9.24% |
| THOMPSON & ASSOCIATES INSURANCE INC3 Filed as: THOMPSON AND ASSOCIATES INS., INC. | 2743 SOUTH SANDPIPER AVENUE ONTARIO, CA 91761 | AFLAC | $185 | $8 | $193 | 3.16% |
| DAVID REESOR3 | 2220 EAST ROUTE 66, SUITE 215 GLENDORA, CA 91740 | AFLAC | $113 | $8 | $121 | 1.98% |
| EVELYN RIVERA3 | 45 COUNTRY WOOD DRIVE POMONA, CA 91766 | AFLAC | $55 | $20 | $75 | 1.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | AFLAC | $73 | — | $73 | 1.20% |
| ESTHER KIM3 | 1915 BATSON AVENUE APARTMENT 37 ROWLAND HEIGHTS, CA 91748 | AFLAC | $66 | — | $66 | 1.08% |
| MJ INSURANCE3 Filed as: ALFRED RIETKERK AND VARIOUS AGENTS | 3120 NE 47TH STREET FORT LAUDERDALE, FL 33308 | AFLAC | $16 | — | $16 | 0.26% |
| TODD V MASON3 Filed as: TODD MASON | 6164 LAWRENCE STREET CRYPRESS, CA 90630 | AFLAC | $6 | — | $6 | 0.10% |
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 173 | $723K |
| Dental(2 contracts, 2 carriers) | UDC DENTAL OF CALIFORNIA, INC. | 116 | $37K |
| Vision | EYEMED VISION CARE | 162 | $11K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 173 | $723K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 173 | $723K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 173 | $729K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.