| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EPIC3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN INC | $37K | — | $37K | 2.72% |
| EPIC3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS SERVICE | $12K | — | $12K | 5.00% |
| EPIC3 | 5350 OLD REDWOOD HIGHWAY, SUITE 600 PETALUMA, CA 94954 | AMERITAS LIFE INSURANCE CORPORATION | $9K | — | $9K | 8.19% |
| EPIC3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 10.76% |
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 | 272 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 275 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 194 | $1.6M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 257 | $106K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 257 | $106K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 165 | $55K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 165 | $55K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 194 | $1.6M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 165 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.