| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UBF INSURANCE SERVICES, INC.3 | 2033 N. MAIN ST SUITE 700 WALNUT CREEK, CA 94596 | AETNA LIFE INSURANCE COMPANY AND AFFLIATES | $118K | $8K | $126K | 4.87% |
| UBF INSURANCE SERVICES, INC.3 | 2033 N. MAIN ST SUITE 700 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN, INC | $10K | $0 | $10K | 5.34% |
| UBF INSURANCE SERVICES, INC.3 | 2033 N. MAIN ST SUITE 700 WALNUT CREEK, CA 94596 | SUNLIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 4.36% |
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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY AND AFFLIATES | 367 | $2.8M |
| Dental | SUNLIFE ASSURANCE COMPANY OF CANADA | 198 | $173K |
| Vision | SUNLIFE ASSURANCE COMPANY OF CANADA | 198 | $173K |
| Life insurance | SUNLIFE ASSURANCE COMPANY OF CANADA | 198 | $173K |
| Other | SUNLIFE ASSURANCE COMPANY OF CANADA | 198 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 367 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.