| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SIDERS INSURANCE SOLUTIONS LLC3 Filed as: SIDERS INSURANCE SOLUTIONS | 3108 PONTE MORENO DRIVE, SUITE 111 CAMERON PARK, CA 95682 | KAISER FOUNDATION HEALTH PLAN, INC. | $22K | $0 | $22K | 2.81% |
| GARY ERICKSON3 | 6770 STANFORD RANCH ROAD, UNIT 1082 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN, INC. | $10K | $0 | $10K | 1.28% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | $0 | $7K | 0.86% |
| SAMANTHA SIDERS3 Filed as: SAMANTHA SIDER | 3108 PONTE MORENO DRIVE, SUITE 111 CAMERON PARK, CA 95682 | WESTERN HEALTH ADVANTAGE | $20K | $0 | $20K | 10.86% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 1100 LARKSPUR LANDING CIRCLE SUITE 180 LARKSPUR, CA 94939 | WESTERN HEALTH ADVANTAGE | $9K | $0 | $9K | 5.00% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | WESTERN HEALTH ADVANTAGE | $8K | $0 | $8K | 4.41% |
| SIDERS INSURANCE SOLUTIONS LLC3 Filed as: SIDERS INSURANCE SOLUTIONS | 3108 PONTE MORENO DRIVE, SUITE 111 CAMERON PARK, CA 95682 | DELTA DENTAL OF CALIFORNIA | $7K | $0 | $7K | 4.86% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | DELTA DENTAL OF CALIFORNIA | $5K | $0 | $5K | 3.39% |
| GARY ERICKSON3 | 1645 WOODHAVEN CIRCLE ROSEVILLE, CA 95747 | DELTA DENTAL OF CALIFORNIA | $2K | $0 | $2K | 1.74% |
| GARY ERICKSON3 | 901 SUNRISE AVENUE, SUITE A15 ROSEVILLE, CA 95661 | HARTFORD LIFE AND ACCIDENT | $442 | $0 | $442 | 1.86% |
| SAMANTHA SIDERS3 | 3108 PONTE MORENO DRIVE, SUITE 111 CAMERON PARK, CA 95682 | HARTFORD LIFE AND ACCIDENT | $442 | $0 | $442 | 1.86% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | HARTFORD LIFE AND ACCIDENT | $307 | $0 | $307 | 1.29% |
| SIDERS INSURANCE SOLUTIONS LLC3 Filed as: SIDERS INSURANCE SOLUTIONS | 3108 PONTE MORENO DRIVE, SUITE 111 CAMERON PARK, NY 95682 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.36% |
| PROFESSIONAL GROUP PLAN INC3 | 225 WIRELESS BOULEVARD, 2ND FLOOR HAUPPAGE, NY 11788 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $982 | $0 | $982 | 5.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2220 DOUGLAS BOULEVARD, SUITE 170 ROSEVILLE, CA 95661 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $519 | $0 | $519 | 2.64% |
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 | 314 | 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) | 314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 155 | $983K |
| Dental | DELTA DENTAL OF CALIFORNIA | 173 | $136K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 379 | $20K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 326 | $24K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 155 | $983K |
| Other | HARTFORD LIFE AND ACCIDENT | 326 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 379 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.