| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 520 CAPITOL MALL, #500 SACRAMENTO, CA 95817 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 4.77% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, LLC | 333 INDIAN HILL BLVD. CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $58 | — | $58 | 0.09% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES | 1277 TREAT BLVD, #650 WALNUT CREEK, CA 94597 | STANDARD INSURANCE COMPANY | $855 | — | $855 | 7.77% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 1277 TREAT BLVD., #650 WALNUT CREEK, CA 94597 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $948 | — | $948 | 10.00% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 520 CAPITOL MALL, #500 SACRAMENTO, CA 95814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $311 | — | $311 | 7.01% |
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 | 111 | 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) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 111 | $553K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 86 | $61K |
| Vision | STANDARD INSURANCE COMPANY | 76 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $4K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $0 |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.