| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES, USA | 959 SKYWAY ROAD, 2ND FLOOR SAN CARLOS, CA 94070 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $171K | — | $171K | 1.70% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES, INC | 150 N MICHIGAN AVE SUITE 3900 CHICAGO, IL 606017604 | KAISER FOUNDATION HEALTH PLAN INC. | $109K | — | $109K | 1.99% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | $31K | — | $31K | 3.06% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES, INC | 150 N MICHIGAN AVE STE 3900 CHICAGO, IL 606017604 | KAISER FOUNDATION HEALTH PLAN INC | $12K | — | $12K | 1.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO OF CA | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $59K | — | $59K | 12.37% |
| HAFT JOSEPH PETER3 | 321 33RD STREET SACRAMENTO, CA 95816 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $6K | — | $6K | 2.99% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA, | P. O. BOX 39000 SAN FRANSISCO, CA 941390001 | VISION SERVICE PLAN | $4K | — | $4K | 2.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVS USA | PO BOX 601478 CHARLOTTE, NC 28260 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | — | $6K | 32.69% |
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 | 2,096 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 2,096 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,601 | $17.3M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,601 | $10.0M |
| Vision | VISION SERVICE PLAN | 969 | $196K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,601 | $10.5M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,966 | $478K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,966 | $478K |
| Prescription drug(5 contracts, 4 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,601 | $17.3M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 192 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,601 | — |
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.