| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PBR INSURANCE SERVICES3 | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 945834383 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 4.14% |
| PBR INSURANCE SERVICES3 | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 945834383 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 4.14% |
| KATHRYN VICTORIA BOSMANS3 Filed as: KATHRYN BOSMANS | 2440 CAMINO RAMON SUITE 375 SAN RAMON, CA 94583 | OXFORD HEALTH INSURANCE, INC. | $3K | — | $3K | 3.37% |
| PBR INSURANCE SERVICES3 | — | DELTA DENTAL OF CALIFORNIA | $9K | — | $9K | 10.00% |
| PREMIER BENEFIT RESOURCES INC3 | 2440 CAMINO RAMON SUITE 375 SAN RAMON, CA 94583 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $4K | — | $4K | 5.10% |
| KATHRYN VICTORIA BOSMANS3 | 2440 CAMINO RAMON SUITE 375 SAN RAMON, CA 94583 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $2K | — | $2K | 2.95% |
| PREMIER BENEFIT RESOURCES INC3 | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 945834395 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| BOSMANS, KATHRYN V.3 | 2440 CAMINO RAMON SUITE 375 SAN RAMON, CA 94583 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $204 | — | $204 | 2.12% |
| PREMIER BENEFIT RESOURCES INC3 Filed as: PREMIER BENEFIT RESOURCES | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 94583 | VISION SERVICE PLAN | $702 | — | $702 | 7.76% |
| PREMIER BENEFIT RESOURCES INC3 | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 945834395 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $879 | — | $879 | 10.00% |
| PREMIER BENEFIT RESOURCES INC3 | 2440 CAMINO RAMON STE 375 SAN RAMON, CA 945834395 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $650 | — | $650 | 10.00% |
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 | 140 | 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. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 70 | $883K |
| Dental | DELTA DENTAL OF CALIFORNIA | 178 | $90K |
| Vision | VISION SERVICE PLAN | 52 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $17K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $9K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.