| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 1039-A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | BLUE CROSS OF CALIFORNIA | $57K | — | $57K | 2.33% |
| WELLS FARGO INSURANCE SERVICES3 | 959 SKYWAY ROAD, 2ND FLOOR SAN CARLOS, CA 94070 | HARTFORD LIFE AND ACCIDENT | $8K | — | $8K | 6.79% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203588 DALLAS, TX 75320 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 1.98% |
| WELLS FARGO INSURANCE SERVICES3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 1.69% |
| WELLS FARGO INSURANCE SERVICES3 | 2480 NATOMAS DRIVE, SUITE 200 SACRAMENTO, CA 95833 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 0.95% |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 20 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 592 | $2.4M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 246 | $125K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 246 | $125K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 592 | $2.4M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 592 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 592 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.