| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 150 N MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $44K | — | $44K | 2.05% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 150 N MICHIGAN AVE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $37K | — | $37K | 2.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | P.O. BOX 220748 CHARLOTTE, NC 28222 | HEALTHKEEPERS, INC. | $8K | — | $8K | 3.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC | P.O. BOX 201503 DALLAS, TX 75320 | HUMANA INSURANCE CO. | $4K | — | $4K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS | PO BOX 601478 CHARLOTTE, NC 282601478 | HARTFORD LIFE AND ACCIDENT | $18K | $876 | $19K | 11.76% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES, USA | P.O. BOX 220748 CHARLOTTE, NC 28222 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $2K | — | $2K | 3.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA | 5200 N PALM AVE SUITE 114 FRESNO, CA 937042225 | AMERITAS LIFE INSURANCE CORPORATION | — | $362 | $362 | 1.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC | P.O. BOX 201503 DALLAS, TX 75320 | HUMANA INSURANCE CO. | $2K | — | $2K | 14.32% |
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 | 195 | 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) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 592 | $4.5M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 440 | $23K |
| Vision | HEALTHKEEPERS, INC. | 40 | $263K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 488 | $169K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 488 | $158K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 488 | $169K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 592 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.