| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN SAN FRANCISCO, CA 94118 | KAISER FOUNDATION HEALTH PLAN INC | $48K | — | $48K | 4.37% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC | — | $3 | $3 | 0.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | CALIFORNIA PHYSICIANS SERVICE | $42K | — | $42K | 5.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 1100 LARKSPUR LANDING CIRCLE SUITE 180 LARKSPUR, CA 94939 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 7.65% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, LLC | 333 INDIAN BOULEVARD CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $142 | — | $142 | 0.05% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 2211 MICHESLON DRIVE, SUITE 1200 IRVINE, CA 92612 | VISION SERVICE PLAN | $523 | — | $523 | 3.45% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE SERVICE | 1100 LARKSPUR LANDING CIRCLE SUITE 180 LARKSPUR, CA 94939 | VISION SERVICE PLAN | $414 | — | $414 | 2.73% |
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 | 210 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 200 | $1.9M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $271K |
| Vision | VISION SERVICE PLAN | 83 | $15K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $271K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $271K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $271K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 200 | $1.9M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 210 | $275K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.