| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | KAISER FOUNDATION HEALTH PLAN INC. | $60K | — | $60K | 3.75% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 3.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 1.29% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $874 | $4K | 20.43% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $843 | $98 | $941 | 16.75% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $375 | $72 | $447 | 8.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PL 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $87 | $10 | $97 | 1.93% |
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 | 215 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 180 | $1.6M |
| Dental | DELTA DENTAL OF CALIFORNIA | 186 | $94K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 260 | $11K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 224 | $26K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 260 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.