| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN INC. | $634 | $42 | $676 | 0.32% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $2 | $1K | 2.05% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC. | 2110 N 40TH STREET, SUITE 234 PHOENIX, AZ 85018 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $276 | — | $276 | 0.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HOLTHOUSE CARLIN & VAN TRIGHT LLP EIN 95-4345526 AUDITOR | Accounting (including auditing) Service code 10 | — | $27K |
| MEKETA FIDUCIARY MGMT LLC OUTSOURCED CIO | Investment advisory (plan) Service code 27 | 5796 ARMAD DRIVE, SUITE 110 CARLSBAD, CA 92008 | $25K |
| US BANK NATIONAL ASSOCIATION CUSTODIAN | Custodial (securities) Service code 19 | 800 NICOLLET MALL MINNEAPOLIS, MN 55402 | $2K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 87 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 87 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 72 | $211K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 87 | $62K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 72 | $211K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 87 | — |
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.