| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | — | $1K | 1.96% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $298 | — | $298 | 0.40% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $40 | $0 | $40 | 7.08% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $17 | $0 | $17 | 3.01% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | GERBER LIFE INSURANCE CO. (MESVISION) | $9 | — | $9 | 4.79% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $8 | $0 | $8 | 6.96% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $3 | $0 | $3 | 2.61% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | GERBER LIFE INSURANCE CO. (MESVISION) | $1 | — | $1 | 6.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $1 | $0 | $1 | 6.67% |
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 | 7 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 7 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 8 | $75K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 2 | $695 |
| Vision(3 contracts, 2 carriers) | GERBER LIFE INSURANCE CO. (MESVISION) | 2 | $219 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.