| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC | $31K | — | $31K | 3.30% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $11K | 15.10% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $7K | $596 | $8K | 19.88% |
| ARGUS BENEFITS4 Filed as: THE ARGUS GROUP INC | 5721 FRENCH LACE COURT NORTH LAS VEGAS, NV 89081 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $377 | — | $377 | 5.72% |
| JERRY B. RAY4 Filed as: JERRY B RAY | 201 KNOXVILLE AVENUE HUNTINGOTN BEACH, CA 92648 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $328 | — | $328 | 4.98% |
| KIM GOODSITE4 | 3400 AVENUE OF THE ARTS APT B313 COSTA MESA, CA 92625 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $48 | — | $48 | 0.73% |
| HEFFERNAN INSURANCE BROKERS4 | 1350 CARLBACK AVE., SUITE 200 WALNUT CREEK, CA 94596 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $45 | — | $45 | 0.68% |
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 | 166 | 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) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 137 | $939K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $73K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $73K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $73K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $73K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $73K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 137 | $939K |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 157 | $120K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.