| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DESIGNED PROTECTION INSURANCE SVCS3 Filed as: DESIGNED PROTECTION INS SERVICES | 150 N SAN DIMAS AVENUE SUITE 201 SAN DIMAS, CA 91773 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | $0 | $17K | 3.41% |
| PETER C. FOY & ASSOCIATES3 Filed as: PETER C FOY & ASSOC INS SERVICES | 6200 CANOGA AVENUE SUITE 325 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | $0 | $3K | 0.67% |
| DESIGNATED PROTECTION INS SERVICES3 | 150 N SAN DIMAS AVENUE SUITE 201 SAN DIMAS, CA 91773 | AETNA LIFE INSURANCE CO. | $23K | $0 | $23K | 4.93% |
| PETER C. FOY & ASSOCIATES3 Filed as: PETER C FOY & ASSOC INS SERVICES | 6200 CANOGA AVENUE SUITE 325 WOODLAND HILLS, CA 91367 | AETNA LIFE INSURANCE CO. | $5K | $0 | $5K | 1.05% |
| DESIGNED PROTECTION INSURANCE SVCS3 Filed as: DESIGNED PROTECTION INSURANCE | 150 N SAN DIMAS AVENUE SUITE 201 SAN DIMAS, CA 91773 | AETNA HEALTH OF CALIFORNIA, INC. | $8K | $0 | $8K | 4.24% |
| PETER C. FOY & ASSOCIATES3 Filed as: PETER C FOY & ASSOC INS SERVICES | 6200 CANOGA AVENUE SUITE 325 WOODLAND HILLS, CA 91367 | AETNA HEALTH OF CALIFORNIA, INC. | $1K | $0 | $1K | 0.76% |
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 | 240 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 240 | $968K |
| Dental | AETNA LIFE INSURANCE CO. | 240 | $462K |
| Vision | AETNA LIFE INSURANCE CO. | 240 | $462K |
| Life insurance | AETNA LIFE INSURANCE CO. | 240 | $462K |
| Other | AETNA LIFE INSURANCE CO. | 240 | $462K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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.