| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 10940 WHITEROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS SERVICE | $33K | $800 | $33K | 4.09% |
| WELLS FARGO INSURANCE SERVICES3 | 600 HIGHWAY 169 SOUTH, 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 3.50% |
| WELLS FARGO INSURANCE SERVICES3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90703 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 4.00% |
| WELLS FARGO INSURANCE SERVICES3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | VISION SERVICE PLAN | $1K | — | $1K | 5.76% |
| WELLS FARGO INSURANCE SERVICES3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 10.90% |
| WELLS FARGO INSURANCE SERVICES3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | HARTFORD LIFE AND ACCIDENT | — | $367 | $367 | 2.15% |
| WELLS FARGO INSURANCE SERVICES3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | MANAGED HEALTH NETWORK | $176 | — | $176 | 4.99% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 144 | $1.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 198 | $68K |
| Vision | VISION SERVICE PLAN | 96 | $18K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 100 | $17K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 100 | $17K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 144 | $1.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 105 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.