| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 2.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 5901 PRIESTLY DRIVE, SUITE 306 CARLSBAD, CA 92008 | PREMIER ACCESS INSURANCE COMPANY | $6K | — | $6K | 10.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 3440 WALNUT AVENUE, 2ND FLOOR FREEMONT, CA 94538 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 10.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10 SOUTH WACKER DRIVE, 17TH FLOOR CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | — | $172 | $172 | 1.10% |
| HEALTH BNFT PARTNERS INS SOLUTIONS3 | 26522 LA ALAMEDA, SUITE 130 MISSION VIEJO, CA 92691 | HARTFORD LIFE AND ACCIDENT | -$3 | — | -$3 | -0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BOULEVARD TORRENCE, CA 90504 | EYEMED | $778 | — | $778 | 9.18% |
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 | 133 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 123 | $703K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 197 | $58K |
| Vision | EYEMED | 118 | $8K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 93 | $16K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 123 | $703K |
| Other | HARTFORD LIFE AND ACCIDENT | 93 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.