| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DORSEY, HAZELTINE, MORGAN, & WYNNE | PO BOX 4306 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN, INC. | $40K | — | $40K | 3.45% |
| M3 INSURANCE SOLUTIONS INC Filed as: WRAITH SCARLETT & RANDOLPH INSURANC | 509 BUSH ST WOODLAND, CA 95695 | KAISER FOUNDATION HEALTH PLAN, INC. | $13K | — | $13K | 1.14% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 3.83% |
| WRAITH, SCARLETT & RANDOLPH3 Filed as: WRAITH SCARLETT&RANDOLPH INS SRV IN | 509 BUSH ST WOODLAND, CA 95695 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.34% |
| DORSEY, HAZELTINE, MORGAN, & WYNNE3 | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $755 | — | $755 | 0.77% |
| DORSEY, HAZELTINE, MORGAN, & WYNNE3 | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 11.32% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 3.77% |
| WRAITH, SCARLETT & RANDOLPH3 Filed as: WRAITH SCARLETT&RANDOLPH INS SRV IN | 509 BUSH ST WOODLAND, CA 95695 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.68% |
| DORSEY, HAZELTINE, MORGAN, & WYNNE3 | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $151 | — | $151 | 7.49% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $76 | $76 | 3.77% |
| WRAITH, SCARLETT & RANDOLPH3 Filed as: WRAITH SCARLETT&RANDOLPH INS SRV IN | 509 BUSH ST WOODLAND, CA 95695 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $50 | — | $50 | 2.48% |
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 | 199 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 199 | $1.2M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $99K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $28K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 6 | $2K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $28K |
| 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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.