| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT KELLEY3 Filed as: SCOTT KELLY | P.O. BOX 892 FOLSOM, CA 95763 | CALIFORNIA PHYSICIANS SERVICE | $21K | — | $21K | 0.96% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS SERVICE | $3K | $2K | $5K | 0.25% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | KAISER PERMANENTE | $19K | — | $19K | 0.96% |
| SCOTT KELLEY3 Filed as: SCOTT KELLY | P.O. BOX 892 FOLSOM, CA 95763 | KAISER PERMANENTE | $17K | — | $17K | 0.85% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | KAISER PERMANENTE | $4K | — | $4K | 0.19% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | DELTA DENTAL OF CALIFORNIA | $11K | — | $11K | 2.40% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 0.25% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 8.41% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 0.80% |
| SCOTT KELLEY3 | P.O. BOX 892 FOLSOM, CA 95763 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 0.79% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | VISION SERVICE PLAN | $1K | — | $1K | 1.54% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 8.11% |
| SCOTT KELLEY3 | P.O. BOX 892 FOLSOM, CA 95763 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $708 | — | $708 | 1.04% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $581 | — | $581 | 0.85% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 8.24% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | DELTA DENTAL OF CALIFORNIA | $582 | — | $582 | 0.94% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | KAISER PERMANENTE | $594 | — | $594 | 1.04% |
| SCOTT KELLEY3 | P.O. BOX 892 FOLSOM, CA 95763 | KAISER PERMANENTE | $416 | — | $416 | 0.73% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | KAISER PERMANENTE | $132 | — | $132 | 0.23% |
| VERUS INSURANCE SERVICES, LLC3 Filed as: VERUS INSURANCE SERVICES | 6085 DOUGLAS BLVD., SUITE 400 GRANITE BAY, CA 95746 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 8.30% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $225 | — | $225 | 0.86% |
| SCOTT KELLEY3 Filed as: SCOTT KELLY | P.O. BOX 892 FOLSOM, CA 95763 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $219 | — | $219 | 0.84% |
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 | 831 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 124 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 955 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 355 | $4.2M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 540 | $517K |
| Vision | VISION SERVICE PLAN | 505 | $73K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 821 | $138K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 831 | $68K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 355 | $4.2M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 831 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 831 | — |
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.