| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERWEST INSURANCE SERVICES, LLC3 | PO BOX 255188 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC | $38K | — | $38K | 4.99% |
| INTERWEST INSURANCE SERVICES, LLC3 | 100 PRINGLE AVENUE, SUITE 550 WALNUT CREEK, CA 94596 | ANTHEM BLUE CROSS | $17K | — | $17K | 5.46% |
| INTERWEST INSURANCE SERVICES, LLC3 | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 6.13% |
| INTERWEST INSURANCE SERVICES, LLC3 | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | UNION SECURITY INSURANCE COMPANY | $6K | $1K | $7K | 26.52% |
| LISA L BASS4 Filed as: LISA L. BASS | 1152 RANCH POINT WAY ANTIOCH, CA 94531 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $731 | — | $731 | 24.11% |
| INTERWEST INSURANCE SERVICES, LLC4 | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $564 | — | $564 | 18.60% |
| CHARLES N. LLOYD4 | 9107 TANDOM DRIVE FORT WASHINGTON, MD 20744 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $126 | — | $126 | 4.16% |
| ALICE J HINDS4 Filed as: ALICE J. HINDS | 2175 RANCHO WAY PITTSBURG, CA 94565 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $114 | — | $114 | 3.76% |
| SOPHIE C POUTEAU4 Filed as: SOPHIE C. POUTEAU | 363 OLD QUARRY ROAD NORTH LARKSPUR, CA 94939 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $100 | — | $100 | 3.30% |
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 | 279 | 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) | 279 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 146 | $1.1M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 279 | $146K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 279 | $146K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 279 | $173K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 279 | $146K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 279 | $146K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 146 | $1.1M |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 277 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.