| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | WESTERN HEALTH ADVANTAGE | $37K | — | $37K | 2.28% |
| SIDERS INSURANCE SOLUTIONS LLC3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 2.42% |
| GARY ERICKSON3 | 901 SUNRISE AVENUE, SUITE A15 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 2.42% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | KAISER FOUNDATION HEALTH PLAN INC. | -$4 | — | -$4 | -0.00% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | DELTA DENTAL OF CALIFORNIA | $6K | — | $6K | 5.00% |
| SIDERS INSURANCE SOLUTIONS LLC3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 4.13% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 0.87% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | VISION SERVICE PLAN | $1K | — | $1K | 5.00% |
| SIDERS INSURANCE SOLUTIONS LLC3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | VISION SERVICE PLAN | $906 | — | $906 | 4.11% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | VISION SERVICE PLAN | $197 | — | $197 | 0.89% |
| GARY ERICKSON3 | 901 SUNRISE AVENUE, SUITE A15 ROSEVILLE, CA 95661 | HARTFORD LIFE AND ACCIDENT | $544 | — | $544 | 2.71% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | HARTFORD LIFE AND ACCIDENT | $459 | — | $459 | 2.29% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | DELTA DENTAL OF CALIFORNIA (DELTACARE) | $681 | — | $681 | 5.00% |
| SIDERS INSURANCE SOLUTIONS LLC3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA (DELTACARE) | $566 | — | $566 | 4.16% |
| SAMANTHA SIDERS3 | 3108 PONTE MORINO DR, STE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA (DELTACARE) | $115 | — | $115 | 0.84% |
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 | 263 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 156 | $2.4M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 134 | $130K |
| Vision | VISION SERVICE PLAN | 153 | $22K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 371 | $20K |
| Prescription drug(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 156 | $2.4M |
| Other | HARTFORD LIFE AND ACCIDENT | 371 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 371 | — |
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."
No prospect flags tripped on this filing.