| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE ARK INSURANCE SERVICES, INC.3 | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA, INC. | $57K | — | $57K | 2.30% |
| THE ARK INSURANCE SERVICES, INC.3 | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $2K | $12K | 11.57% |
| THOMAS EDWARD BRADBURY3 | 35 BLUE HERON DR FLETCHER, NC 287327539 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 2.99% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: THE ARK INSURANCE SERVICES INC. | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $1K | $9K | 17.07% |
| THE ARK INSURANCE SERVICES, INC.3 | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $644 | $4K | 12.14% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES, INC. | 3740 ELIZABETH STREET RIVERSIDE, CA 925062507 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $380 | $85 | $465 | 12.25% |
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 | 635 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA, INC. | 635 | $2.5M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 377 | $137K |
| Short-term disability(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 377 | $191K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 15 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 635 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.