| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 SMITH RANCH ROAD, SUITE 112 SAN RAFAEL, CA 94903 | CALIFORNIA PHYSICIANS SERVICE | $43K | $946 | $44K | 3.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $2K | $11K | 2.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 1.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $311 | $0 | $311 | 0.28% |
| LTC SOLUTIONS, INC.3 Filed as: LTC SOLUTIONS | UNKNOWN BREA, CA 92821 | MEDAMERICA | $1K | $0 | $1K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | MEDAMERICA | $360 | $0 | $360 | — |
| LTC SOLUTIONS, INC.3 Filed as: LTC SOLUTIONS | UNKNOWN BREA, CA 92821 | PRUDENTIAL INSURANCE | $174 | $0 | $174 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | PRUDENTIAL INSURANCE | $58 | $0 | $58 | — |
| LTC SOLUTIONS, INC.3 Filed as: LTC SOLUTIONS | UNKNOWN BREA, CA 92821 | MUTUAL OF OMAHA LIFE INSURANCE | $3K | $0 | $3K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | MUTUAL OF OMAHA LIFE INSURANCE | $882 | $0 | $882 | — |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | 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)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 180 | $2.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 298 | $136K |
| Vision | VISION SERVICE PLAN | 110 | $18K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $111K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $111K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $111K |
| Prescription drug(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 180 | $2.0M |
| Other(5 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
No prospect flags tripped on this filing.