| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $379 | $379 | 0.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1255 BATTERY STREET, SUITE 450 SAN FRANCISCO, CA 94105 | AETNA LIFE INSURANCE COMPANY | $0 | $87 | $87 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $0 | $785 | $785 | 1.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 SMITH RANCH ROAD, SUITE 112 SAN RAFAEL, CA 94903 | AFLAC | $3K | $0 | $3K | 10.91% |
| KRISTINA J KUNZ3 Filed as: KRISTINA J. KUNZ | 251 CALIFORNIA STREET, SUITE 450 SAN FRANCISCO, CA 94104 | AFLAC | $1K | $308 | $2K | 7.24% |
| MATT SMITH3 | 509 20TH AVENUE SAN FRANCISCO, CA 94121 | AFLAC | $1K | $9 | $1K | 4.39% |
| MJ INSURANCE3 Filed as: CHRIS BRANSON AND VARIOUS AGENTS | 9209 COLBERG DRIVE AUSTIN, TX 78749 | AFLAC | $500 | $93 | $593 | 2.57% |
| TRULY B. PINEDA3 | 601 MONTGOMERY STREET, SUITE 1475 SAN FRANCISCO, CA 94111 | AFLAC | $280 | $2 | $282 | 1.22% |
| ZACHARY ALWEISS NIESEN3 | 35 UNDERHILL ROAD MILL VALLEY, CA 94941 | AFLAC | $241 | $4 | $245 | 1.06% |
| JUDI JONES3 Filed as: JUDI P. JONES | 4583 HARMONY PLACE ROHNERT PARK, CA 94928 | AFLAC | $98 | $0 | $98 | 0.43% |
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 125 | $1.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 254 | $134K |
| Vision | VISION SERVICE PLAN | 111 | $32K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 118 | $39K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 118 | $39K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 125 | $1.2M |
| Other(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 118 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 254 | — |
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.