| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 3.15% |
| HILLENBRAND INSURANCE SERVICES3 | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | — | $8K | 2.25% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES INC | P.O. BOX 255188 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC. | -$37 | — | -$37 | -0.01% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | WESTERN HEALTH ADVANTAGE | $13K | — | $13K | 5.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 4.32% |
| HILLENBRAND INSURANCE SERVICES3 Filed as: HILLENBRAND INSURANCE SERVICES INC. | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $2K | $6K | 3.99% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 4.40% |
| HILLENBRAND INSURANCE SERVICES3 | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 3.14% |
| HILLENBRAND INSURANCE SERVICES3 Filed as: HILLENBRAND INSURANCE SERVICES INC. | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | ANTHEM BLUE CROSS | $4K | — | $4K | 6.35% |
| LISA INC.3 | 1600 WEST HILLSDALE BLVD. SAN MATEO, CA 94402 | ANTHEM BLUE CROSS | — | $2K | $2K | 3.18% |
| IHILLENBRAND INSURANCE SERVICES INC3 | 2267 LAVA RIDGE COURT, SUITE 200 ROSEVILLE, CA 95661 | ANTHEM BLUE CROSS | $666 | — | $666 | 6.38% |
| AMWINS3 Filed as: LISI INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94403 | ANTHEM BLUE CROSS | — | $333 | $333 | 3.19% |
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 | 169 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 87 | $771K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 155 | $151K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 155 | $140K |
| Prescription drug(5 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 87 | $771K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 155 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 155 | — |
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.