| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SSM INSURANCE SERVICES, INC.3 | P.O. BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN INC | $29K | $2 | $29K | 2.98% |
| SSM INSURANCE SERVICES, INC.3 | P.O. BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN INC | $26K | $1 | $26K | 2.99% |
| THE BENEFIT COMPANY INC3 Filed as: THE BENEFIT COMPANY | SIX CONCOURSE PARKWAY SUITE 2750 ATLANTA, CA 30328 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $16K | $0 | $16K | 5.13% |
| WILLIAM DEWEY3 | P.O. BOX 750004 PETALUMA, CA 94975 | HEALTH NET | $7K | $0 | $7K | 4.41% |
| SSM INSURANCE SERVICES, INC.3 | P.O. BOX 750004 PETALUMA, CA 94975 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $19K | $0 | $19K | 14.71% |
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 | 280 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 280 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 154 | $2.3M |
| Dental(2 contracts, 2 carriers) | HEALTH NET | 280 | $296K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 280 | $296K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 280 | $132K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 280 | $132K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 154 | $2.0M |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 280 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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."
No prospect flags tripped on this filing.