| 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. | $66K | — | $66K | 2.70% |
| THE ARK INSURANCE SERVICES, INC.3 | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | — | $14K | 12.30% |
| THOMAS EDWARD BRADBURY3 | 35 BLUE HERON DR FLETCHER, NC 287327539 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $819 | — | $819 | 0.70% |
| 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 | $9K | — | $9K | 15.00% |
| THE ARK INSURANCE SERVICES, INC.3 | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES, INC. | 3740 ELIZABETH ST RIVERSIDE, CA 925062507 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $514 | — | $514 | 10.01% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES, INC. | 3740 ELIZABETH STREET RIVERSIDE, CA 925062507 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $457 | — | $457 | 10.00% |
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 | 646 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 646 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA, INC. | 646 | $2.4M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $149K |
| Short-term disability(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $210K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 16 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 646 | — |
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.