| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC | $18K | $1 | $18K | 3.48% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94974 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $6K | $16K | 3.03% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94974 | KAISER FOUNDATION HEALTH PLAN INC | $3K | $1K | $4K | 2.98% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 1.49% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $3K | $4K | 7.13% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.37% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS SVCS | 808 GLENDALOUGH RD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $126 | $126 | 0.20% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $294 | $507 | $801 | 8.38% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $662 | — | $662 | 6.93% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS SVCS | 808 GLENDALOUGH RD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $20 | $20 | 0.21% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $296 | $514 | $810 | 9.44% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $472 | — | $472 | 5.50% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS SVCS | 808 GLENDALOUGH RD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $20 | $20 | 0.23% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $167 | $358 | $525 | 9.88% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $365 | — | $365 | 6.87% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS SVCS | 808 GLENDALOUGH RD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $14 | $14 | 0.26% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $110 | $192 | $302 | 9.99% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $192 | — | $192 | 6.35% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS SVCS | 808 GLENDALOUGH RD ERDENHEIM, PA 19038 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7 | $7 | 0.23% |
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 | 89 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 92 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 84 | $658K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 49 | $62K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 43 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 78 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 27 | $10K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 84 | $658K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 78 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 84 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.