| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMES-GRENZ INSURANCE SERVICES, INC.3 | 3435 AMERICAN RIVER DR STE C SACRAMENTO, CA 95864 | KAISER FOUNDATION HEALTH PLAN INC. | $38K | $0 | $38K | 4.07% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 | 3435 AMERICAN RIVER DR STE C SACRAMENTO, CA 95864 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $8K | $0 | $8K | 3.41% |
| AMWINS3 Filed as: LISI INC. | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $4K | $4K | 1.54% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 | 3435 AMERICAN RIVER DR STE C SACRAMENTO, CA 95864 | STANDARD INSURANCE COMPANY | $8K | $0 | $8K | 6.22% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 | 3435 AMERICAN RIVER DR STE C SACRAMENTO, CA 95864 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $12K | $0 | $12K | 10.00% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 | 3435 AMERICAN RIVER DR STE C SACRAMENTO, CA 95864 | CALIFORNIA PHYSICIAN SERVICES | $1K | $0 | $1K | 7.50% |
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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 203 | $1.2M |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 110 | $123K |
| Vision | CALIFORNIA PHYSICIAN SERVICES | 96 | $15K |
| Life insurance | STANDARD INSURANCE COMPANY | 100 | $124K |
| Long-term disability | STANDARD INSURANCE COMPANY | 100 | $124K |
| Other | STANDARD INSURANCE COMPANY | 100 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.