| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREINI & COMPANY3 | 220 WEST 20TH AVE. SAN MATEO, CA 94403 | CALIFORNIA PHYSICIANS SERVICE | — | $36K | $36K | 2.17% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CALIFORNIA PHYSICIANS SERVICE | — | $33K | $33K | 2.00% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INSURANCE SERVICES | 220 WEST 20TH AVE. SAN MATEO, CA 94403 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 2.22% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 1.84% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INSURANCE SERVICES | 5060 CALIFORNIA AVE. BAKERSFIELD, CA 93309 | GUARDIAN | $7K | — | $7K | 5.06% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 900 E HAMILTON AVE. SAN MATEO, CA 94403 | GUARDIAN | $7K | — | $7K | 4.83% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $556 | — | $556 | 9.75% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 76 | $2.1M |
| Dental | GUARDIAN | 96 | $136K |
| Vision | GUARDIAN | 96 | $136K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN | 96 | $142K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 96 | $142K |
| Long-term disability | GUARDIAN | 96 | $136K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 76 | $2.1M |
| Other(2 contracts, 2 carriers) | GUARDIAN | 96 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 96 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.