| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLSON CHEUNG3 | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | CHINESE COMMUNITY HEALTH PLAN | $16K | — | $16K | 2.50% |
| ROBERT C. PLACAK & ASSOC. INC.3 Filed as: ROBERT C. PLACAK & ASSO, INC | 790 MISSION AVENUE SAN RAFAEL, CA 94901 | CHINESE COMMUNITY HEALTH PLAN | $13K | — | $13K | 2.00% |
| EDDY M TSE3 | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | CHINESE COMMUNITY HEALTH PLAN | $3K | — | $3K | 0.50% |
| WELLSON CHEUNG3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 2.55% |
| ROBERT C PLACAK & ASSOCIATES3 Filed as: ROBERT C. PLACAK & ASSOCIATES, INC | 790 MISSION AVE SAN RAFAEL, CA 949013207 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 2.04% |
| EDDY M TSE3 Filed as: EDDY TSE | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | KAISER FOUNDATION HEALTH PLAN INC. | $940 | — | $940 | 0.51% |
| CHEUNG, WELLSON W3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | HUMANADENTAL INSURANCE COMPANY | $8K | — | $8K | 7.40% |
| ROBERT C. PLACAK & ASSOC. INC.3 Filed as: ROBERT C PLACAK & ASSOC INC | 790 MISSION AVE SAN RAFAEL, CA 949013207 | HUMANADENTAL INSURANCE COMPANY | $6K | — | $6K | 5.92% |
| TSE, EDDY M3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | HUMANADENTAL INSURANCE COMPANY | $2K | — | $2K | 1.48% |
| WELLSON CHEUNG3 Filed as: WELLSON WAI-SANG CHEUNG | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | HEALTH NET | $2K | $6 | $2K | 3.51% |
| ROBERT C PLACAK & ASSOCIATES3 Filed as: ROBERT C. PLACAK & ASSOCIATES | PERSONAL AND CONFIDENTIAL 790 MISSION AVENUE SAN RAFAEL, CA 94901 | HEALTH NET | $2K | — | $2K | 2.80% |
| EDDY M TSE3 Filed as: EDDY MAN-HO TSE | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | HEALTH NET | $393 | — | $393 | 0.70% |
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 | 159 | 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) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CHINESE COMMUNITY HEALTH PLAN | 129 | $900K |
| Dental | HUMANADENTAL INSURANCE COMPANY | 97 | $106K |
| Other | HUMANADENTAL INSURANCE COMPANY | 97 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.