| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES, USA | 150 N MICHIGAN AVE STE 3900 CHICAGO, IL 606017604 | KAISER FOUNDATION HEALTH PLAN INC | $31K | — | $31K | 2.20% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA, | 10940 WHITE ROCK RD FL 2 RANCHO CORDOVA, CA 956706076 | HEALTH NET | $4K | — | $4K | 2.59% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD., SUITE 100 AGOURA HILLS, CA 91301 | HEALTH NET | $3K | — | $3K | 1.94% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | 10940 WHITE ROCK ROAD 2ND FLOOR RANCHO CORDOVA, CA 95670 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $495 | $2K | 11.38% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD., SUITE 100 AGOURA HILLS, CA 91301 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 6.21% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE - RANCHO CORD | 3440 WALNUT BLD A FL 2 #33667 FREMONT, CA 94538 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $292 | — | $292 | 4.52% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD., SUITE 100 AGOURA HILLS, CA 91301 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $236 | — | $236 | 3.65% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | 10940 WHITE ROCK ROAD 2ND FLOOR RANCHO CORDOVA, CA 95670 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $555 | $164 | $719 | 11.38% |
| HIXME INSURANCE SOLUTIONS, INC.3 | 27489 AGOURA RD., SUITE 100 AGOURA HILLS, CA 91301 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $392 | — | $392 | 6.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | 21250 HAWTHORNE BLVD 6TH FL TORRANCE, CA 90503 | AMERICAN FIDELITY ASSURANCE COMPANY | $535 | — | $535 | 8.72% |
| BENEFITS TECHNOLOGIES LLC3 Filed as: BENEFITS TECHNOLOGIES DIV 6 LLC | 1200 E TAFT AVE SAPULPA, OK 74066 | AMERICAN FIDELITY ASSURANCE COMPANY | $20 | — | $20 | 0.33% |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 263 | $1.6M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 99 | $6K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 213 | $6K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 32 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 213 | $19K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 263 | $1.4M |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 213 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 263 | — |
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.