| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | P.O. BOX 4006 WALNUT CREEK, CA 945961796 | KAISER FOUNDATION HEALTH PLAN INC. | $48K | — | $48K | 3.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | — | $12K | 0.95% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 945967299 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 3.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 1.26% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE WALNUT CREEK, CA 945967299 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PRINCIPAL LIFE INSURANCE COMPANY | $533 | — | $533 | 2.04% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $604 | — | $604 | 3.39% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $690 | — | $690 | 3.93% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE SUITE 200 WALNUT CREEK, CA 94596 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $620 | — | $620 | 8.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $63 | — | $63 | 0.88% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $52 | — | $52 | 2.91% |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 199 | $1.3M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 123 | $148K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 94 | $7K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 124 | $26K |
| Short-term disability(4 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 23 | $38K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 124 | $26K |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 124 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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.