| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 0.50% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 0.49% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX #28852, PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $11K | $11K | 3.12% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $9K | $9K | 2.72% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $4K | $4K | 2.54% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX #28852, PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $4K | $4K | 2.46% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $1K | $1K | 2.67% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX #28852, PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $1K | $1K | 2.33% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $1K | $1K | 3.47% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $873 | $873 | 2.60% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $655 | $3K | 9.19% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 7.90% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 8.05% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $241 | $2K | 7.76% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 175 BERNAL RD SUITE 100 SAN JOSE, CA 95119 | METROPOLITAN GENERAL INSURANCE COMPANY | $1K | — | $1K | 5.08% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | METROPOLITAN GENERAL INSURANCE COMPANY | $1K | — | $1K | 4.12% |
| BUSINESSOLVER.COM, INC.3 | 1025 ASHWORTH ROAD WEST DES MOINES, IA 50265 | METROPOLITAN GENERAL INSURANCE COMPANY | — | $360 | $360 | 1.39% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WATSON WYATT & COMPANY | 901 N. GLEBE ROAD ARLINGTON, VA 22203 | METROPOLITAN GENERAL INSURANCE COMPANY | — | $258 | $258 | 1.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 3155 OLSEN DRIVE SUITE 400 SAN JOSE, CA 95117 | METROPOLITAN GENERAL INSURANCE COMPANY | $206 | — | $206 | 0.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | 1 UPPER POND RD BLDG F PARSIPPANY, NY 07054 | METROPOLITAN GENERAL INSURANCE COMPANY | — | $54 | $54 | 0.21% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX #28852, PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $604 | $604 | 3.36% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $472 | $472 | 2.62% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 345 CALIFORNIA ST, SUITE 2000 SAN FRANCISCO, CA 94104 | ACE AMERICAN INSURANCE COMPANY | $2K | — | $2K | 14.00% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $818 | — | $818 | 8.07% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $704 | $100 | $804 | 7.93% |
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 | 352 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 190 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 943 | $693K |
| Vision | VISION SERVICE PLAN | 353 | $143K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 373 | $371K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 373 | $44K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 348 | $177K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 190 | $1.7M |
| Other(8 contracts, 4 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 373 | $477K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 943 | — |
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.