| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | — | $8K | 2.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 0.75% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | — | $1K | 2.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $404 | — | $404 | 0.85% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | WESTERN HEALTH ADVANTAGE | $2K | — | $2K | 7.99% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $571 | $0 | $571 | 7.00% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $245 | $0 | $245 | 3.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $392 | $0 | $392 | 6.99% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $168 | — | $168 | 3.00% |
| AMES-GRENZ INSURANCE SERVICES, INC.3 Filed as: AMES GRENZ INSURANCE SERVICES INC | 3435 AMERICAN RIVER DRIVE SUITE C SACRAMENTO, CA 95864 | GERBER LIFE INSURANCE CO. (MESVISION) | $82 | — | $82 | 4.98% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $21 | $0 | $21 | 9.95% |
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 | 45 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 45 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 48 | $422K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 21 | $14K |
| Vision(2 contracts, 2 carriers) | GERBER LIFE INSURANCE CO. (MESVISION) | 17 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 48 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.