| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $32K | $0 | $32K | 3.96% |
| NONSTOP ADMINISTRATION & INSURANCE3 Filed as: NONSTOP ADMIN. AND INS. SERVICES | 2300 CLAYTON ROAD, SUITE 1450 CONCORD, CA 94520 | KAISER FOUNDATION HEALTH PLAN INC | $3K | $0 | $3K | 0.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | CHINESE COMMUNITY HEALTH PLAN | $13K | $0 | $13K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $295 | $2K | 11.79% |
| NONSTOP ADMINISTRATION & INSURANCE3 Filed as: NONSTOP ADMIN. AND INS. SERVICES | 2300 CLAYTON ROAD, SUITE 1450 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $175 | $0 | $175 | 1.07% |
| DUBLIN INSURANCE SERVICES, INC.3 Filed as: DUBLIN INSURANCE SERVICES | PO BOX 9026 PLEASANTON, CA 94566 | VISION SERVICE PLAN | $468 | $0 | $468 | 6.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $490 | $0 | $490 | 8.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BOULEVARD SUITE 600 GLENDALE, CA 91203 | PREMIER ACCESS INSURANCE COMPANY | $360 | $0 | $360 | 8.84% |
| NONSTOP ADMINISTRATION & INSURANCE3 Filed as: NONSTOP ADMIN. AND INS. SERVICES | 2300 CLAYTON ROAD, SUITE 1450 CONCORD, CA 94520 | PREMIER ACCESS INSURANCE COMPANY | $31 | $0 | $31 | 0.76% |
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 | 179 | 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) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 184 | $1.1M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 13 | $4K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 179 | $13K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 216 | $16K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 184 | $1.1M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 216 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.