| 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 | $89K | $51K | $140K | 7.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX, INC. EIN 33-0441200 NONE | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | — | $7.9M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Contract Administrator Service code 13 | — | $1.6M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | $577K |
| NATIONAL COMPLIANCE SERVICES EIN 77-0547083 NONE | Accounting (including auditing) Service code 10 | — | $278K |
| WYLIE, MCBRIDE, PLATTEN & RENNER EIN 94-2633731 NONE | Copying and duplicating; Legal; Direct payment from the plan Service code 29 | — | $166K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $102K |
| HSTECHNOLOGY SOLUTIONS INC EIN 27-1818792 NONE | Other services Service code 49 | — | $98K |
| RICHARD J. ROMANSKI NONE | Legal Service code 29 | 3182 CAMPUS DR STE 346 SAN MATEO, CA 94403 | $85K |
| MCMORGAN & COMPANY EIN 52-2334338 NONE | Investment management fees paid directly by plan Service code 51 | — | $72K |
| WHEELER SONOMA PRINTING NONE | Copying and duplicating; Participant communication Service code 36 | 836 SONOMA BLVD VALLEJO, CA 94590 | $66K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $57K |
| HUMAN BEHAVIOR ASSOCIATES EIN 94-3413007 NONE | Other services Service code 49 | — | $50K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Investment advisory (plan); Consulting (general) Service code 16 | — | $50K |
| GEORGE HERNANDEZ NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $40K |
| HEMMING MORSE LLP NONE | Consulting (general) Service code 16 | 180 MONTGOMERY ST STE 1500 SAN FRANCISCO, CA 94104 | $36K |
| TIM BREKKE NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $29K |
| GOLDEN TRIANGLE SPECIALTY NETWORK EIN 26-0821440 NONE | Other fees Service code 99 | — | $24K |
| RAY NANN NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $24K |
| CHARLES GILCHRIST NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $24K |
| WILLIAM E. RIKER NONE | Other services Service code 49 | 15 SANTA PAULA AVE SAN FRANCISCO, CA 94127 | $17K |
| STATE STREET BANK & TRUST CO. EIN 23-7404790 NONE | Other fees; Trustee (directed) Service code 25 | — | $14K |
| FREMONT BANK NONE | Other services Service code 49 | 25151 CLAWITER RD HAYWARD, CA 94545 | $13K |
| H. JIM EDWARDS NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $10K |
| JIM BEARD NONE | Trustee (individual) Service code 20 | 5 THOMAS MELLON CIR STE 111 SAN FRANCISCO, CA 94134 | $9K |
| MARK SHARWOOD NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $5K |
| PAUL D. STAUDOHAR NONE | Other services Service code 49 | 1140 BROWN AVE LAFAYETTE, CA 94549 | $5K |
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 | 8,851 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 8,851 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 8,180 | $76.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 8,635 | $6.5M |
| Vision | VISION SERVICE PLAN | 3,668 | $503K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 8,561 | $144K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 3,038 | $1.8M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 8,561 | $144K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,635 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.