| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN INC | $15K | — | $15K | 1.76% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INSURANCE SVCS | 5701 LONETREE BLVD STE 111 ROCKLIN, CA 95765 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 0.41% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 2.34% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INSURANCE SVCS | 5701 LONETREE BLVD STE 111 ROCKLIN, CA 95765 | KAISER FOUNDATION HEALTH PLAN INC | $367 | — | $367 | 0.25% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 5.84% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INSURANCE SVCS | 5701 LONETREE BLVD STE 111 ROCKLIN, CA 95765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $804 | $4K | 5.18% |
| CASSIDYS ASSOCIATED INSURERS INC3 | 376 W OBRIEN DR HAGATNA, GU 96910 | HARTFORD LIFE AND ACCIDENT | $287 | — | $287 | 10.00% |
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 | 202 | 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) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 109 | $1.1M |
| Vision(2 contracts) | TAKECARE | 7 | $89K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 195 | $82K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 195 | $82K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 195 | $82K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 109 | $1.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 195 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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.