| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 140 2ND STREET, SUITE 318 PETALUMA, CA 94952 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $176K | $0 | $176K | 19.50% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 2270 DOUGLAS BOULEVARD, SUITE 220 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN, INC. | $10K | $0 | $10K | 5.34% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | $0 | $2K | 1.14% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $22K | $0 | $22K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PARKWAY WEST, SUITE 320 BLUE BELL, PA 19422 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 20.30% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 2040 MAIN STREET, SUITE 450 IRVINE, CA 92614 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 15.25% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 1800 BLANKENSHIP ROAD, SUITE 360 WEST LINN, OR 97068 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.94% |
| SELMAN & COMPANY, LLC3 Filed as: SELMAN AND COMPANY, LLC | 1 INTEGRITY PARKWAY CLEVELAND, OH 44143 | PRINCIPAL LIFE INSURANCE COMPANY | — | $704 | $704 | 3.44% |
| RSC INSURANCE BROKERAGE INC4 Filed as: RSC INSURANCE BROKERAGE, INC. | 2040 MAIN STREET, SUITE 450 IRVINE, CA 92614 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $2K | $0 | $2K | 17.00% |
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 | 128 | 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) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 25 | $181K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 230 | $914K |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 230 | $921K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 130 | $170K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 130 | $170K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 130 | $170K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 25 | $181K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 130 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.