| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | KAISER FOUNDATION HEALTH PLAN INC | $30K | $0 | $30K | 3.89% |
| OWEN AND COMPANY3 Filed as: OWEN AND DUNN | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | KAISER FOUNDATION HEALTH PLAN INC | $3K | $0 | $3K | 0.40% |
| ASSUREDPARTNERS3 | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | CALIFORNIA PHYSICIANS SERVICE | $6K | $0 | $6K | 4.01% |
| AMWINS3 Filed as: LISI, INC | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS SERVICE | $3K | $0 | $3K | 2.00% |
| OWEN AND COMPANY3 | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | CALIFORNIA PHYSICIANS SERVICE | $1K | $0 | $1K | 1.01% |
| AMWINS3 Filed as: LISI, INC. | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | PREMIER ACCESS INSURANCE COMPANY | $1K | $0 | $1K | 1.97% |
| ASSUREDPARTNERS3 | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 10.00% |
| AMWINS3 Filed as: LISI, INC. | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $2K | $2K | 5.00% |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 171 | $912K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 270 | $57K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 192 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 192 | $36K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 171 | $912K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 192 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.