| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS SERVICE | $23K | — | $23K | 5.00% |
| RBJ SAN JOSE3 | 6155 ALMADEN EXPRESSWAY, SUITE 210 SAN JOSE, CA 95120 | CALIFORNIA PHYSICIANS SERVICE | $9K | — | $9K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 45 FREMONT, SUITE 800 SAN FRANCISCO, CA 94105 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 4.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10 SOUTH WACKER DRIVE, 17TH FLOOR CHICAGO, IL 60606 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.24% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, LLC | 333 INDIAN HILL BOULEVARD CLAREMONT, CA 91771 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $105 | — | $105 | 0.09% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 3.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 3.53% |
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 278 | $534K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 278 | $534K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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.