| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | WESTERN HEALTH ADVANTAGE | $22K | — | $22K | 1.77% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | WESTERN HEALTH ADVANTAGE | $8K | — | $8K | 0.64% |
| GARY ERICKSON3 | 901 SUNRISE AVENUE, SUITE A15 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | — | $22K | 2.99% |
| SIDERS INSURANCE SOLUTIONS LLC3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 0.86% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 0.33% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | DELTA DENTAL OF CALIFORNIA | $9K | — | $9K | 6.95% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 3.05% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | VISION SERVICE PLAN | $2K | — | $2K | 6.91% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | VISION SERVICE PLAN | $675 | — | $675 | 3.09% |
| GARY ERICKSON3 | 901 SUNRISE AVENUE, SUITE A15 ROSEVILLE, CA 95661 | HARTFORD LIFE AND ACCIDENT | $869 | — | $869 | 5.00% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | DELTA DENTAL OF CALIFORNIA (DELTACARE) | $670 | — | $670 | 6.69% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA (DELTACARE) | $331 | — | $331 | 3.31% |
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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 150 | $2.0M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 129 | $136K |
| Vision | VISION SERVICE PLAN | 140 | $22K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 257 | $17K |
| Prescription drug(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 150 | $2.0M |
| Other | HARTFORD LIFE AND ACCIDENT | 257 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.