| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE WALNUT CREEK, CA 94596 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $35K | — | $35K | 6.46% |
| PATRA CORPORATION3 | 1107 INVESTMENT BLVD SUITE 100 EL DORADO HILLS, CA 95762 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $30K | — | $30K | 5.41% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC | $10K | — | $10K | 2.89% |
| PATRA CORPORATION3 | 1107 INVESTMENT BLVD SUITE 100 EL DORADO HILLS, CA 95762 | KAISER FOUNDATION HEALTH PLAN INC | $6K | — | $6K | 1.66% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE WALNUT CREEK, CA 94596 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $4K | $7K | $11K | 5.76% |
| PATRA CORPORATION3 Filed as: PATRA INSURANCE | 1107 INVESTMENT BLVD SUITE 100 EL DORADO HILLS, CA 95762 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $3K | — | $3K | 1.58% |
| HEFFERNAN INSURANCE BROKERS3 Filed as: HEFFERNAN INS BROKERS | 1350 CARLBACK AVE WALNUT CREEK, CA 94596 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $29 | $6K | 9.61% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC | 1000 BURNETT AVE STE 440 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 5.41% |
| PATRA CORPORATION3 | 1107 INVESTMENT BLVD STE 100 EL DORADO HILLS, CA 95762 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 3.62% |
| HEFFERNAN INSURANCE BROKERS3 Filed as: HEFFERNAN INS BROKERS | 1350 CARLBACK AVE. WALNUT CREEK, CA 94596 | METROPOLITAN LIFE INSURANCE COMPANY | — | $34 | $34 | 0.46% |
| PATRA CORPORATION3 | 1107 INVESTMENT BLVD STE100 EL DORADO HILLS, CA 95762 | METROPOLITAN LIFE INSURANCE COMPANY | $3 | — | $3 | 0.04% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC | 1000 BURNETT AVE STE 440 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO | Non-monetary compensation; Claims processing; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Other services; Float revenue Service code 12 | — | $16K |
| CIGNA HEALTH & LIFE INSURANCE CO | Named fiduciary; Other services; Claims processing; Direct payment from the plan; Non-monetary compensation; Participant communication; Float revenue; Contract Administrator Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO. | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | — | $0 |
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 | 207 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 192 | $894K |
| Dental | GUARDIAN LIFE INSURANCE CO OF AMERICA | 0 | $196K |
| Vision | GUARDIAN LIFE INSURANCE CO OF AMERICA | 0 | $196K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 303 | $73K |
| Short-term disability(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 303 | $73K |
| Long-term disability(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 303 | $73K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 192 | $894K |
| Other(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 303 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.