| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | $0 | $5K | 1.94% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | $0 | $2K | 0.60% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | WESTERN HEALTH ADVANTAGE | $10K | — | $10K | 8.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $78 | $0 | $78 | 7.25% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $75 | $0 | $75 | 6.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $40 | $0 | $40 | 7.08% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $17 | $0 | $17 | 3.01% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | GERBER LIFE INSURANCE CO. (MESVISION) | $8 | $0 | $8 | 4.94% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $1 | $0 | $1 | 6.67% |
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 | 24 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 24 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 28 | $380K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 3 | $2K |
| Vision(2 contracts, 2 carriers) | GERBER LIFE INSURANCE CO. (MESVISION) | 1 | $177 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 28 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.