| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 1350 TREAT BOULEVARD, SUITE 550 WALNUT CREEK, CA 94597 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $292K | — | $292K | 1.52% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 601478 CHARLOTTE, NC 28260 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $80K | $80K | 0.42% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $13K | $13K | 0.07% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF,SIEBELS & WILLIAMS, INC. | PO BOX 10265 BIRMINGHAM, AL 35202 | VISION SERVICE PLAN | $119K | — | $119K | 3.50% |
| WELLS FARGO INSURANCE SERVICES3 | 1350 TREAT BOULEVARD SUITE 550 WALNUT CREEK, CA 94597 | HYATT LEGAL PLANS | $53K | — | $53K | 7.92% |
| WELLS FARGO INSURANCE SERVICES3 | 64 MONROE AVENUE NW SUITE 300 GRAND RAPIDS, MI 49503 | HYATT LEGAL PLANS | — | $8K | $8K | 1.18% |
| WELLS FARGO INSURANCE SERVICES3 | 11017 COBBLEROCK DRIVE #100 RANCHO CORDOVA, CA 95670 | HYATT LEGAL PLANS | — | $5K | $5K | 0.76% |
| WELLS FARGO INSURANCE SERVICES3 | 1018 W 9TH AVENUE KING OF PRUSSIA, PA 19406 | HYATT LEGAL PLANS | — | $27 | $27 | 0.00% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 601478 CHARLOTTE, NC 28260 | HYATT LEGAL PLANS | — | $18 | $18 | 0.00% |
| WELLS FARGO INSURANCE SERVICES3 | 1350 TREAT BOULEVARD, SUITE 550 WALNUT CREEK, CA 94597 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $28K | $7K | $35K | 9.49% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS & WILLIAMS, INC | PO BOX 10265 BIRMINGHAM, AL 35202 | DELTA DENTAL OF VIRGINIA | $21K | — | $21K | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 | UNKNOWN NEWPORT NEWS, VA 23607 | MONUMENTAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.17% |
| JEFF HALSETH3 | UNKNOWN NEWPORT NEWS, VA 23607 | MONUMENTAL LIFE INSURANCE COMPANY | $3K | — | $3K | 2.35% |
| WELLS FARGO INSURANCE SERVICES3 | 1350 TREAT BOULEVARD SUITE 550 WALNUT CREEK, CA 94597 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $766 | $2K | 3.20% |
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 | 32,663 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 174 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 805 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 33,642 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 6 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 638 | $4.1M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF VIRGINIA | 209 | $320K |
| Vision | VISION SERVICE PLAN | 16,861 | $3.4M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,731 | $19.3M |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,731 | $19.6M |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,731 | $19.6M |
| Prescription drug(6 contracts, 6 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 638 | $4.1M |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,937 | $20.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 33,937 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.