| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $0 | $697 | $697 | 1.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 SMITH RANCH ROAD, SUITE 122 SAN RAFAEL, CA 94903 | AFLAC | $4K | $0 | $4K | 10.27% |
| KRISTINA J KUNZ3 Filed as: KRISTINA J. KUNZ | 118 GRANVILLE WAY SAN FRANCISCO, CA 94127 | AFLAC | $3K | $201 | $3K | 6.79% |
| MATT SMITH3 | 509 20TH AVENUE SAN FRANCISCO, CA 94121 | AFLAC | $2K | $250 | $2K | 5.54% |
| TRULY B. PINEDA3 | 601 MONTGOMERY STREET, SUITE 1475 SAN FRANCISCO, CA 94111 | AFLAC | $631 | $50 | $681 | 1.70% |
| MJ INSURANCE3 Filed as: DANIEL GRIFFIN AND VARIOUS AGENTS | 104 BURGANDY COURT MARTINEZ, CA 94553 | AFLAC | $475 | $25 | $500 | 1.25% |
| ZACHARY ALWEISS NIESEN3 Filed as: ZACHARY ALWEISS NEISEN | 35 UNDERHILL ROAD MILL VALLEY, CA 94941 | AFLAC | $380 | $30 | $410 | 1.02% |
| JUDI JONES3 Filed as: JUDI P. JONES | 4583 HARMONY PLACE ROHNERT PARK, CA 94928 | AFLAC | $126 | $0 | $126 | 0.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.11% |
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 | 115 | 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) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 133 | $1.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 248 | $147K |
| Vision | VISION SERVICE PLAN | 111 | $36K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 119 | $42K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 119 | $42K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 133 | $1.4M |
| Other(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 119 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 248 | — |
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.