| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN, INC. | $35K | — | $35K | 3.77% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 15005 CONCORD CIR, STE 110 MORGAN HILL, CA 95037 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | — | $11K | 1.19% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 6.94% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 15005 CONCORD CIR, STE 110 MORGAN HILL, CA 95037 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $579 | $4K | 3.62% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 6.71% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 15005 CONCORD CIR, STE 110 MORGAN HILL, CA 95037 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $817 | $82 | $899 | 3.61% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $155 | — | $155 | 6.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 15005 CONCORD CIR, STE 110 MORGAN HILL, CA 95037 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $72 | $6 | $78 | 3.45% |
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 | 107 | 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. |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 103 | $927K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 86 | $104K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $27K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 103 | $927K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.