| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREGORY ALBIN3 | 2010 CROW CANYON PL STE 100 SAN RAMON, CA 94583 | KAISER FOUNDATION HEALTH PLAN, INC | $6K | — | $6K | 0.86% |
| GREGORY ALBIN3 Filed as: GREGORY J ALBIN | 2010 CROW CANYON PL SUITE 100 SAN RAMON, CA 94583 | WESTERN HEALTH ADVANTAGE | $2K | — | $2K | 0.70% |
| GREGORY ALBIN3 | 2010 CROW CANYON PLACE, #100 SAN RAMON, CA 94583 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 0.70% |
| RICHARD WENTZ3 Filed as: RICHARD WETNZ | PO BOX 610 SANTA CLARA, CA 95052 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $584 | — | $584 | 0.30% |
| GREGORY ALBIN3 Filed as: GREGORY J. ALBIN | — | CALIFORNIA CHOICE | $8K | — | $8K | 4.50% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | — | CALIFORNIA CHOICE | $5K | — | $5K | 2.97% |
| RICHARD A. WENTZ3 | — | CALIFORNIA CHOICE | $3K | — | $3K | 1.93% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $6K | — | $6K | 9.36% |
| ALBIN, GREGORY J3 | 2010 CROW CANYON PLACE 100 SAN RAMON, CA 94583 | BLUE CROSS OF CALIFORNIA | $2K | — | $2K | 2.99% |
| KERR, WELDON G3 | RBG SAN JOSE 6155 ALMADEN EXPWY #210 SAN JOSE, CA 95120 | BLUE CROSS OF CALIFORNIA | $2K | — | $2K | 2.43% |
| WENTZ, RICHARD A3 | 1190 HOMESTEAD ROAD SANTA CLARA, CA 95050 | BLUE CROSS OF CALIFORNIA | $850 | — | $850 | 1.28% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INS CTR | 135 MAIN ST 21ST FLOOR SAN FRANCISCO, CA 94105 | BLUE CROSS OF CALIFORNIA | $483 | — | $483 | 0.73% |
| GREGORY ALBIN3 | 2010 CROW CANYON PL STE 100 SAN RAMON, CA 94583 | KAISER FOUNDATION HEALTH PLAN INC | $568 | — | $568 | 4.16% |
| RICHARD WENTZ3 | PO BOX 610 SANTA CLARA, CA 95052 | KAISER FOUNDATION HEALTH PLAN INC | $244 | — | $244 | 1.79% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | PO BOX 5668 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC | $74 | — | $74 | 0.54% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GRP INC | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | METROPOLITAN LIFE INSURANCE COMPANY | $312 | $312 | $624 | 8.83% |
| GREGORY ALBIN3 | 2010 CROW CANYON PL STE 100 SAN RAMON, CA 94583 | METROPOLITAN LIFE INSURANCE COMPANY | $611 | — | $611 | 8.65% |
| RICHARD WENTZ3 | PO BOX 610 SANTA CLARA, CA 95052 | METROPOLITAN LIFE INSURANCE COMPANY | $262 | — | $262 | 3.71% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GRP INC | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | METROPOLITAN LIFE INSURANCE COMPANY | $60 | $60 | $120 | 8.94% |
| GREGORY ALBIN3 | 2010 CROW CANYON PL STE 100 SAN RAMON, CA 94583 | METROPOLITAN LIFE INSURANCE COMPANY | $116 | — | $116 | 8.64% |
| RICHARD WENTZ3 | PO BOX 610 SANTA CLARA, CA 95052 | METROPOLITAN LIFE INSURANCE COMPANY | $50 | — | $50 | 3.72% |
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 | 335 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 335 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 211 | $896K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 319 | $195K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 400 | $8K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 83 | $67K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 83 | $67K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 25 | $66K |
| Other(3 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 400 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.