| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | 600 HIGHWAY 169 S 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN INC | $83K | — | $83K | 4.97% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 150 N MICHIGAN AVE STE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 0.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | PO BOX 39000 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | PO BOX 39000 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 3.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | 959 SKYWAY RD, SUITE 200 SAN CARLOS, CA 94070 | VISION SERVICE PLAN | $3K | — | $3K | 2.35% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS. SVCS USA INC. | PO BOX 39000 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | PO BOX 39000 SAN FRANCISCO, CA 94139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.15% |
| INSURANCE TO GO3 | 500 PROFESSIONAL CENTER DR. SUITE 515 NOVATO, CA 94947 | FOUR EVER LIFE INS CO. | $2K | — | $2K | 12.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | 45 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $206 | — | $206 | 4.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA INC. | 49 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $59 | — | $59 | 2.20% |
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 | 602 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 606 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 372 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,439 | $607K |
| Vision | VISION SERVICE PLAN | 627 | $126K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 827 | $212K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 658 | $69K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 652 | $135K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 372 | $1.7M |
| Other(4 contracts, 4 carriers) | CONCERN EAP | 726 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,439 | — |
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.