| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LINCOLN INSURANCE SERVICES3 | 1660 OLYMPIC BOULEVARD, SUITE 201 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC | $38K | — | $38K | 4.94% |
| LINCOLN INSURANCE SERVICES3 | 1660 OLYMPIC BOULEVARD, SUITE 201 WALNUT CREEK, CA 94596 | PREMIER ACCESS INSURANCE COMPANY | $5K | — | $5K | 6.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3 EMBARCADERO CENTER, SUITE 560 SAN FRANCISCO, CA 94111 | PREMIER ACCESS INSURANCE COMPANY | $93 | — | $93 | 0.13% |
| LINCOLN INSURANCE SERVICES3 | 1660 OLYMPIC BOULEVARD, SUITE 201 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | — | $1K | 5.43% |
| LINCOLN INSURANCE SERVICES3 | 1660 OLYMPIC BOULEVARD, SUITE 201 WALNUT CREEK, CA 94596 | AFLAC | $513 | — | $513 | 2.83% |
| MARK A. MUELLER3 Filed as: MARK MUELLER | 4145 SHADOW LANE APARTMENT 413 SANTA ROSA, CA 95405 | AFLAC | $487 | — | $487 | 2.69% |
| LOUIS CHANGLER CASTLEBERRY3 Filed as: LOUIS CASTLEBERRY AND OTHER AGENTS | 1260 NORTH DUTTON AVENUE SUITE 180 SANTA ROSA, CA 95401 | AFLAC | $408 | $14 | $422 | 2.33% |
| EVAN GRZEJKA3 | 1140 4TH STREET, APARTMENT 240 SANTA ROSA, CA 94504 | AFLAC | $266 | $36 | $302 | 1.67% |
| SEMRA ERDEN3 Filed as: SEMRA EDEN | 235 WILLOWGREEN PLACE SANTA ROSA, CA 95403 | AFLAC | $288 | — | $288 | 1.59% |
| MICHAEL BOOTH3 | 740 4TH STREET SANTA ROSA, CA 95404 | AFLAC | $151 | — | $151 | 0.83% |
| KATHLEEN BASSINI3 | 146 JACK LONDON DRIVE SANTA ROSA, CA 95409 | AFLAC | $151 | — | $151 | 0.83% |
| LINCOLN INSURANCE SERVICES3 | 1660 OLYMPIC BOULEVARD, SUITE 201 WALNUT CREEK, CA 94596 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 8.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 400 TAYLOR BOULEVARD, SUITE 300 PLEASANT HILL, CA 94523 | HARTFORD LIFE AND ACCIDENT | $206 | — | $206 | 1.69% |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 121 | $804K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 184 | $74K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 190 | $12K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 190 | $12K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 121 | $786K |
| Other(2 contracts, 2 carriers) | AFLAC | 190 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.