| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES INC. | 150 N. MICHIGAN AVE STE 3900 CHICAGO, IL 606017604 | KAISER FOUNDATION HEATLH PLAN, INC. | $0 | $48K | $48K | 1.32% |
| WRAITH, SCARLETT & RANDOLPH3 | 622 MAIN STREET WOODLAND, CA 95695 | CAPITAL DISTRICT PHYSICAN'S HEALTH PLAN INC. | — | — | $0 | 0.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERV USA INC | 600 HWY 169 S, FL 18 ATTN TREASURY DEPARTMENT ST LOUIS PARK, MN 554261205 | METROPOLITAN LIFE INSURANCE COMPANY | — | $27 | $27 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC. | 959 SKYWAY RD 2ND FL SAN CARLOS, CA 940702719 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 6.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | 959 SKYWAY RD FL 2 SAN CARLOS, CA 940702719 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $134 | $24 | $158 | 0.13% |
| WRAITH, SCARLETT & RANDOLPH3 | 622 MAIN STREET WOODLAND, CA 95695 | VISION SERVICE PLAN | $1K | $0 | $1K | 2.68% |
| WRAITH, SCARLETT & RANDOLPH3 | 622 MAIN STREET WOODLAND, CA 95695 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC. | 959 SKYWAY RD FL 2 SAN CARLOS, CA 940702719 | FIRST UNUM LIFE INSURANCE COMPANY | $178 | $9 | $187 | — |
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 | 370 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 50 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEATLH PLAN, INC. | 704 | $4.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 866 | $303K |
| Vision | VISION SERVICE PLAN | 325 | $52K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 409 | $119K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 409 | $119K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEATLH PLAN, INC. | 704 | $4.5M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 409 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 866 | — |
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.