| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EPIC3 | 425 CALIFORNIA ST STE 2400 SAN FRANCISCO, CA 94104 | KAISER FOUNDATION HEALTH PLAN | $8K | — | $8K | 0.10% |
| EPIC3 | 10877 WHITE ROCK RD STE 300 RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $34K | — | $34K | 2.00% |
| EPIC3 | 10877 WHITE ROCK RD STE 300 RANCHO CORDOVA, CA 95670 | WESTERN HEALTH ADVANTAGE | $13K | — | $13K | 2.00% |
| HEALTH INSURANCE SERVICES3 | 306 S WASHINGTON AVE STE 206 ROYAL OAK, MI 48067 | UNITED AMERICAN INSURANCE COMPANY | $39K | — | $39K | 8.31% |
| EPIC3 | PO BOX 5668 CONCORD, CA 94524 | WESTERN HEALTH ADVANTAGE | $9K | — | $9K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE #1 EMPLOYEE | Employee (plan); Plan Administrator Service code 14 | 2525 CLEVELAND AVE STE C SANTA ROSA, CA 95403 | $95K |
| EMPLOYEE #2 EMPLOYEE | Employee (plan); Plan Administrator Service code 14 | 2525 CLEVELAND AVE STE C SANTA ROSA, CA 95403 | $77K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $49K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $25K |
| NAVIA BENEFIT SOLUTIONS EIN 91-1467758 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $25K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL NONE | Legal; Direct payment from the plan Service code 29 | 369 PINE ST #800 SAN FRANCISCO, CA 94104 | $20K |
| COMPLIANCE AUDIT SERVICES EIN 94-3134229 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| IBEW LOCAL 551 EIN 94-1104872 RELATED PTY | Other services; Direct payment from the plan Service code 49 | — | $15K |
| SALTZMAN & JOHNSON NONE | Legal; Direct payment from the plan Service code 29 | 5100 B1 CLAYTON RD STE 373 CONCORD, CA 94521 | $11K |
| VINTAGE COMMUNICATIONS EIN 47-2450345 NONE | Direct payment from the plan; Other fees Service code 50 | — | $6K |
| DODGE & COX EIN 94-1441976 NONE | Direct payment from the plan; Investment management Service code 28 | — | $5K |
| INTERCONTINENTAL REAL ESTATE CORP NONE | Investment management; Direct payment from the plan Service code 28 | 1270 SOLDIERS FIELD RD BOSTON, MA 02135 | $0 |
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 | 442 | 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) | 529 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN | 948 | $10.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,134 | $0 |
| Vision | VISION SERVICE PLAN | 533 | $40K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE CO | 439 | $6K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 211 | $2.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE CO | 439 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,134 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.