| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 959 SKYWAY ROAD, 2ND FLOOR SAN CARLOS, CA 94070 | BLUE CROSS OF CALIFORNIA | $136K | — | $136K | 3.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC. | $41K | — | $41K | 2.34% |
| WELLS FARGO INSURANCE SERVICES3 | 959 SKYWAY ROAD, 2ND FLOOR SAN CARLOS, CA 94070 | DELTA DENTAL OF CALIFORNIA | $390 | — | $390 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 959 SKYWAY ROAD, 2ND FLOOR SAN CARLOS, CA 94070 | VISION SERVICE PLAN | $3K | — | $3K | 2.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $2K | — | $2K | 15.00% |
| WELLS FARGO INSURANCE SERVICES3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $308 | — | $308 | 2.75% |
| HECTOR MATHA4 | 40754 FLYING SEA ROAD PALM DESERT, CA 92211 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $798 | — | $798 | 9.11% |
| VINCENT P. FERANDA, IV4 Filed as: VINCENT P. FERANDA IV | 774 VANDAL WAY PALMDALE, CA 93551 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $716 | — | $716 | 8.18% |
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 | 331 | 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) | 331 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 328 | $5.9M |
| Dental | DELTA DENTAL OF CALIFORNIA | 825 | $614K |
| Vision | VISION SERVICE PLAN | 323 | $109K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 288 | $4.2M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 288 | $4.2M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 288 | $4.2M |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 328 | $5.9M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 337 | $4.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 825 | — |
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.