| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST STE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $31K | — | $31K | 5.00% |
| GORDON WILLIAMSON3 | PO BOX 2579 APPLETON, WI 54912 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 3.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SOUTHWEST SERVICE ADMINISTRATORS EIN 86-0785790 NONE | Contract Administrator; Claims processing Service code 12 | — | $4.8M |
| CIGNA HEALTHCARE OF ARIZONA NONE | Other fees Service code 99 | 11001 N BLOCK CYN STE 300 PHOENIX, AZ 85029 | $2.4M |
| ACA TRANSITIONAL REINSURANCE PRGM NONE | Other fees Service code 99 | 7500 SECURITY BLVD BALTIMORE, MD 21244 | $1.2M |
| BLUECROSS BLUESHIELD OF AZ., INC. EIN 86-0004538 NONE | Other fees Service code 99 | — | $403K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Claims processing Service code 10 | — | $311K |
| SAFEWAY HEALTH INC NONE | Other fees Service code 99 | 5918 STONERIDGE MALL RD PLEASANTON, CA 94588 | $284K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $244K |
| HEALTH MANAGEMENT CONCEPTS, INC. EIN 75-3189468 NONE | Other fees Service code 99 | — | $207K |
| PATIENT CARE PARTNERSHIP EIN 86-1005647 NONE | Other fees Service code 99 | — | $188K |
| CREWS MACQUARRIE & ASSOCIATES, INC. NONE | Consulting (general) Service code 16 | 2855 MICHELLE DR STE 100 IRVINE, CA 92606 | $187K |
| DAVIS, COWELL & BOWE, LLP EIN 94-1709555 NONE | Legal Service code 29 | — | $162K |
| REINHART BOERNER VAN DEUREN, S.C. EIN 39-1126909 NONE | Other fees Service code 99 | — | $161K |
| TELADOC, INC. NONE | Other fees Service code 99 | 1945 LAKEPOINTE DR LEWISVILLE, TX 75057 | $144K |
| VISION SERVICE PLAN EIN 23-7293853 NONE | Other fees Service code 99 | — | $124K |
| TOTAL DENTAL ADMINISTRATORS NONE | Other fees Service code 99 | 2111 E HIGHLAND AVE STE 250 PHOENIX, AZ 85016 | $113K |
| PRESBYTERIAN HEALTH PLAN EIN 85-0105601 NONE | Other fees Service code 99 | — | $99K |
| PATIENT-CENTERED OUTCOMES RES INST. NONE | Other fees Service code 99 | 1828 L ST NW STE 900 WASHINGTON, DC 20036 | $63K |
| BANK OF AMERICA EIN 86-0005300 NONE | Other fees Service code 99 | — | $51K |
| UNITED CONCORDIA EIN 95-4146179 NONE | Other fees Service code 99 | — | $33K |
| SEAGALL BRYANT & HAMILL EIN 41-1788385 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $20K |
| THE VIRTUOUS GROUP NONE | Consulting (general) Service code 16 | 1930 VILLAGE CENTER CIR LAS VEGAS, NV 89134 | $20K |
| NEW ENGLAND PENSION CONSULTANTS EIN 04-2927339 NONE | Investment advisory (participants) Service code 26 | — | $15K |
| CATAMARAN, INC. EIN 98-0167449 NONE | Other fees Service code 99 | — | $12K |
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Other fees Service code 99 | — | $9K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 NONE | Custodial (securities) Service code 19 | — | $8K |
| FRANK STEGMAN TRUSTEE | Other fees Service code 99 | 2400 W DUNLAP AVE STE 250 PHOENIX, AZ 85021 | $6K |
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 | 16,300 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 16,300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,000 | $344K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 22,918 | $284K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 9,953 | $958K |
| Other(5 contracts, 5 carriers) | HMC HEALTHWORKS | 22,918 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 22,918 | — |
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.