| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 Filed as: LUMITY INC | 5214F DIAMOND HTS BLVD UNIT #1152 SAN FRANCISCO, CA 94131 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 18.67% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES | 2100 ROSS AVENUE SUITE 1200 DALLAS, TX 75201 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $46 | — | $46 | 0.06% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 E 3RD AVENUE SAN MATEO, CA 944014010 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 5.16% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SRVCS, LLC | 2677 N MAIN STREET SUITE 800 SANTA ANA, CA 927056687 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | — | $1K | 2.26% |
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 | 117 | 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) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 197 | $1.1M |
| Dental | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 115 | $83K |
| Vision | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 115 | $83K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 197 | $1.1M |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 197 | $1.1M |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 197 | $1.1M |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 197 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.