| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 10940 WHITE ROCK ROAD SECOND FLOOR RANCHO CORDOVA, CA 95670 | BLUE SHIELD OF CALIFORNIA | $220K | $4K | $224K | 4.07% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 600 HIGHWAY 169 S 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN | $103K | — | $103K | 4.10% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HWATHORNE BLVD STE 600 TORRANCE, CA 90503 | METROPOLITAN LIFE INSURANCE COMPANY | $23K | — | $23K | 3.66% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES INC | 1018 W 9TH AVE KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $9K | $9K | 1.37% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $49K | $2K | $51K | 15.75% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $10K | — | $10K | 4.29% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | SAFEGUARD HEALTH PLANS, INC A CALIFORNIA CORPORATION | $3K | — | $3K | 3.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSRUANCE SERVICES USA | 108 W 9TH AVE KING OF PRUSSIA, PA 19406 | SAFEGUARD HEALTH PLANS, INC A CALIFORNIA CORPORATION | $0 | $1K | $1K | 1.37% |
| JIMMY H HALL3 Filed as: JIMMY HALL | 220 8TH STREET MANHATTAN BEACH, CA 90266 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $157 | $157 | 0.70% |
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 | 963 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 976 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 537 | $8.2M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 569 | $712K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 963 | $326K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 963 | $326K |
| Prescription drug(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 537 | $8.2M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 963 | $571K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 963 | — |
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.