| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERWEST INSURANCE SERVICES, LLC3 | 426 14TH STREET, SUITE 117 MODESTO, CA 95354 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 4.58% |
| INTERWEST INSURANCE SERVICES, LLC3 | 1357 E. LASSEN AVE CHICO, CA 95973 | VISION SERVICE PLAN | $1K | — | $1K | 4.71% |
| SEAN A CRISP3 | 426 14TH STREET, #117 MODESTO, CA 95356 | VISION SERVICE PLAN | $78 | — | $78 | 0.30% |
| BETH A. GRIFFIN3 Filed as: BETH A GRIFFIN | 9102 E LATHROP ROAD MANTECA, CA 95336 | AFLAC | $1K | $91 | $1K | 5.50% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | AFLAC | $1K | $8 | $1K | 4.52% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $180 | $14 | $194 | 0.78% |
| GUSTAVO ARRIAGA II3 | 320 W CORK TREE DRIVE ORANGE, CA 92865 | AFLAC | $149 | — | $149 | 0.60% |
| SEAN CRISP & ASSOCIATES3 Filed as: SEAN CRISP AND ASSOCIATES | 426 14TH STREET, SUITE 117 MODESTO, CA 95354 | AFLAC | $145 | — | $145 | 0.59% |
| LANCE WALUSKO3 | 3903 STORY RD DENAIR, CA 95316 | AFLAC | $112 | $7 | $119 | 0.48% |
| DAVID B. KITCHEN3 Filed as: DAVID B KITCHEN | 5230 HARTER LANE LA CANADA, CA 91011 | AFLAC | $88 | — | $88 | 0.36% |
| INTERWEST INSURANCE SERVICES, LLC3 | PO BOX 8110 CHICO, CA 95927 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 5.90% |
| SEAN CRISP & ASSOCIATES3 | 426 14TH STREET, #117 MODESTO, CA 95354 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $968 | — | $968 | 4.91% |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 14 | $82K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 153 | $20K |
| Vision | VISION SERVICE PLAN | 142 | $26K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 153 | $20K |
| Stop-loss / reinsurancereinsurance | SWISS RE CORPORATE SOLUTIONS | 110 | $741K |
| Other(2 contracts, 2 carriers) | AFLAC | 153 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.