| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL A. KAMIMOTO3 | 11270 KONOCTI VISTA DR. SPC3 31 LOWER LAKE, CA 954579767 | SUTTER HEALTH PLAN | $11K | — | $11K | 1.25% |
| MICHAEL A. KAMIMOTO3 | 11270 KONOCTI VISTA DRIVE SPC. 31 LOWER LAKE, CA 95457 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 10.91% |
| MICHAEL A. KAMIMOTO3 | P.O. BOX 225085 SAN FRANCISCO, CA 94122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 16.80% |
| MICHAEL A. KAMIMOTO3 | 11270 KONOCTI VISTA DRIVE SPC. 31 LOWER LAKE, CA 95457 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 10.90% |
| MICHAEL A. KAMIMOTO3 | P.O. BOX 225085 SAN FRANCISCO, CA 94122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $894 | — | $894 | 10.01% |
| MICHAEL A. KAMIMOTO3 | 11270 KONOCTI VISTA DRIVE SPC.31 LOWER LAKE, CA 95457 | MANAGED HEALTH NETWORK | $148 | — | $148 | 5.00% |
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 | 126 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUTTER HEALTH PLAN | 88 | $848K |
| Dental | BLUE CROSS OF CALIFORNIA | 129 | $43K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 148 | $9K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $20K |
| Prescription drug | SUTTER HEALTH PLAN | 88 | $848K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 158 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.