| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN, INC | $11K | — | $11K | 2.12% |
| ROGERS BENEFIT GROUP INC3 | 669 RIVER DRIVE CENTER II SUITE 305 ELMWOOD PARK, NJ 07407 | UNITEDHEALTHCARE INSURANCE COMPANY | $15K | — | $15K | 3.29% |
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WALNUT CREEK, CA 94596 | UNITEDHEALTHCARE INSURANCE COMPANY | $14K | — | $14K | 3.00% |
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN, INC | $2K | — | $2K | 1.38% |
| HEFFERNAN INSURANCE BROKERS3 | 44 MONTGOMERY ST STE 1950 SAN FRANCISCO, CA 94104 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $40 | $12K | 9.87% |
| ROGERS BENEFIT GROUP INC3 | 2502 N ROCKY POINT DR STE 310 TAMPA, FL 33607 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $1K | $7K | 5.91% |
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 | 145 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 66 | $1.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.