| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | CALIFORNIA PHYSICIANS' SERVICE | — | $4K | $4K | 0.10% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | AETNA HEALTH, INC. | — | $1K | $1K | 0.25% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 4040 CIVIC CENTER DRIVE SAN RAFAEL, CA 94903 | AETNA HEALTH, INC. | — | $68 | $68 | 0.02% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INSURANCE | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 0.55% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 750 LINDARO STREET, SUITE 210 SAN RAFAEL, CA 94901 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27K | — | $27K | 53.95% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 750 LINDARO STREET, SUITE 210 SAN RAFAEL, CA 94901 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26K | — | $26K | 61.04% |
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 | 1,539 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,547 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,557 | $12.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 2,310 | $1.1M |
| Vision | VISION SERVICE PLAN | 1,267 | $139K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,458 | $195K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,458 | $244K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,458 | $195K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,557 | $12.0M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,458 | $302K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,310 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.