| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE, SUITE 200 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLANS INC | $29K | — | $29K | 3.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNITED HEALTHCARE INSURANCE COMPANY | $25K | — | $25K | 5.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 9.96% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | HARTFORD LIFE AND ACCIDENT | $5K | — | $5K | 10.00% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $769 | $43 | $812 | 14.12% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE, SUITE 200 WALNUT CREEK, CA 94596 | CALIFORNIA DENTAL NETWORK, INC. | $340 | — | $340 | 10.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | MANAGED HEALTH NETWORK | $138 | — | $138 | 5.00% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | EYEMED VISION CARE | $200 | — | $200 | 9.23% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE, SUITE 200 WALNUT CREEK, CA 94596 | HYATT LEGAL PLANS, INC. | $215 | — | $215 | 10.10% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVENUE, SUITE 200 WALNUT CREEK, CA 94596 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $143 | — | $143 | 15.05% |
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 | 136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLANS INC | 170 | $1.5M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $100K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC | 170 | $968K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 133 | $51K |
| Short-term disability | AFLAC | 8 | $6K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 133 | $51K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC | 170 | $1.5M |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 230 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.