| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREINI AND COMPANY3 | 220 WEST 20TH AVENUE SAN MATEO, CA 94403 | KAISER FOUNDATION HEALTH PLAN INC | $95K | — | $95K | 5.24% |
| ANDREINI & COMPANY3 | 220 W 20TH AVE SAN MATEO, CA 94403 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $115K | — | $115K | 11.63% |
| ANDREINI & COMPANY3 | 220 W 20TH AVE SAN MATEO, CA 94403 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | — | $17K | 10.00% |
| ANDREINI & COMPANY3 | 220 W 20TH AVE SAN MATEO, CA 94403 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | — | $9K | 14.94% |
| ANDREINI & COMPANY3 | 220 W 20TH AVE SAN MATEO, CA 94403 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| ANDREINI & COMPANY3 | 220 W 20TH AVE SAN MATEO, CA 94403 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIMS ADMINISTRATION | Float revenue; Contract Administrator; Named fiduciary; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $369K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $21K |
| CIGNA HEALTH & LIFE INSURANCE CO. | Participant communication; Named fiduciary; Non-monetary compensation; Float revenue; Other services; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $0 |
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 | 462 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 466 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 183 | $1.8M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 130 | $174K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $31K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 183 | $1.8M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 305 | $988K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 462 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 462 | — |
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.