| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PARKVILLE INS SVCS INC3 | PO BOX 1275 WHITTIER, CA 90609 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 1.94% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC | $13K | $2 | $13K | 1.36% |
| PARKVILLE INS SVCS INC3 | PO BOX 1275 WHITTIER, CA 90609 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 6.22% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 4.65% |
| PARKVILLE INS SVCS INC3 | PO BOX 1275 WHITTIER, CA 90609 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 9.90% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $836 | — | $836 | 6.48% |
| PARKVILLE INS SVCS INC3 | PO BOX 1275 WHITTIER, CA 90609 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $812 | — | $812 | 8.59% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $553 | — | $553 | 5.85% |
| JERRY B. RAY4 Filed as: JERRY B RAY | 201 KNOXVILLE AVENUE HUNTINGOTN BEACH, CA 92648 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $378 | — | $378 | 5.66% |
| KIM GOODSITE4 | 3400 AVENUE OF THE ARTS APT B313 COSTA MESA, CA 92625 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $165 | — | $165 | 2.47% |
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 | 160 | 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) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 137 | $964K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 25 | $40K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $22K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $9K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $9K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 137 | $964K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.