Form 5500 · Employee benefit plan · RODEO, CA
ON-SITE HEALTH & SAFETY
ON-SITE HEALTH & SAFETY of RODEO, CA spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is ACRISURE PARTNERS WEST COAST. Coverage is written through ANTHEM BLUE CROSS and 3 other carriers. The plan's most recent policy period ended in October.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 71-1003664 · plan 501 · plan year 2025, filed Apr 1, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life and disability; the largest, with ANTHEM BLUE CROSS, covers 47 people.
Reported premium across the insured contracts is $616,093, with $51,747 in disclosed broker commissions — about 8.4% of premium.
The most recent policy period ended in October, and the plan year ends October 31. Group contracts typically renew on that annual cycle.
ACRISURE PARTNERS WEST COAST is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including ANTHEM BLUE CROSS, KAISER FOUNDATION HEALTH PLAN, INC., THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and MEDIEXCEL HEALTH PLAN. ANTHEM BLUE CROSS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 176 | Nov 1, 2025 | $129,918 | $21,881 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 29 | Nov 1, 2025 | $201,545 | $14,440 |
| ANTHEM BLUE CROSS | Health, Dental, Vision | 47 | Nov 1, 2025 | $225,068 | $11,409 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 10 | Nov 1, 2025 | $52,408 | $3,490 |
| MEDIEXCEL HEALTH PLAN | Health | 2 | Nov 1, 2025 | $7,154 | $527 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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