| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC. | $51K | — | $51K | 4.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 5.14% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 12.53% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $818 | — | $818 | 4.58% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $132 | — | $132 | 0.79% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 94596 | ANTHEM BLUE CROSS LIFE & HEALTH INSURANCE COMPANY | $765 | — | $765 | 9.57% |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 213 | $1.3M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 128 | $143K |
| Vision | ANTHEM BLUE CROSS LIFE & HEALTH INSURANCE COMPANY | 100 | $8K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $27K |
| Short-term disability(3 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 21 | $36K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $27K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 213 | $1.3M |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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.