| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LYNN GURNHAM | 1575 BOSTON POST RD STE 6 GUILFORD, CT 064372319 | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | — |
| LYNN GURNHAM | 1575 BOSTON POST RD STE 6 GUILFORD, CT 064372319 | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | 887 MITTEN ROAD BURLINGAME, CA 94010 | $169K |
| MDG BENEFIT SOLUTIONS EIN 27-2928672 NONE | Participant communication Service code 38 | 34 EAST INDUSTRIAL ROAD, SUITE 5 BRANFORD, CT 06405 | $21K |
| GALLINA LLP EIN 94-2147510 NONE | Accounting (including auditing) Service code 10 | 2870 GOLD TAILINGS COURT RANCHO CORDOVA, CA 95670 | $11K |
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 | 410 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 410 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 41 | $200K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 41 | — |
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.