| 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 | $97K | $55K | $152K | 7.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX, INC. EIN 33-0441200 NONE | Claims processing; Direct payment from the plan; Float revenue; Other fees Service code 12 | — | $8.0M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Contract Administrator Service code 13 | — | $1.6M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $585K |
| NATIONAL COMPLIANCE SERVICES EIN 77-0547083 NONE | Accounting (including auditing) Service code 10 | — | $251K |
| HSTECHNOLOGY SOLUTIONS INC EIN 27-1818792 NONE | Other services Service code 49 | — | $138K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $123K |
| RICHARD J. ROMANSKI NONE | Legal; Direct payment from the plan Service code 29 | 3182 CAMPUS DR STE 346 SAN MATEO, CA 94403 | $85K |
| WYLIE, MCBRIDE, PLATTEN & RENNER EIN 94-2633731 NONE | Copying and duplicating; Legal Service code 29 | — | $81K |
| CHARTWELL INVESTMENT PARTNERS LLC EIN 36-4776242 NONE | Investment management fees paid directly by plan Service code 51 | — | $68K |
| WHEELER SONOMA PRINTING EIN 20-8452680 NONE | Copying and duplicating; Other services Service code 36 | — | $67K |
| AMERICAN REALTY ADVISORS EIN 33-0123114 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $61K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $54K |
| HUMAN BEHAVIOR ASSOCIATES EIN 94-3413007 NONE | Other services Service code 49 | — | $51K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Consulting (general); Investment advisory (plan) Service code 16 | — | $50K |
| WEDGE CAPITAL MANAGEMENT LLP EIN 56-1557450 NONE | Investment management fees paid directly by plan Service code 51 | — | $38K |
| GOLDEN TRIANGLE SPECIALTY NETWORK EIN 26-0821440 NONE | Other services; Direct payment from the plan Service code 49 | — | $32K |
| GEORGE HERNANDEZ NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $30K |
| TIM BREKKE NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $29K |
| 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 |
| FREMONT BANK EIN 94-1569025 NONE | Other services Service code 49 | — | $13K |
| JIM BEARD NONE | Trustee (individual) Service code 20 | 5 THOMAS MELLON CIR STE 111 SAN FRANCISCO, CA 94134 | $10K |
| STATE STREET BANK & TRUST CO. EIN 23-7404790 NONE | Trustee (directed); Other fees Service code 25 | — | $10K |
| H. JIM EDWARDS NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $10K |
| STEPHEN HORN INSURANCE SERVICE EIN 94-3249244 NONE | Insurance brokerage commissions and fees Service code 53 | — | $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 | 9,218 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 9,218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 8,276 | $76.5M |
| Dental(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 5,128 | $3.9M |
| Vision | VISION SERVICE PLAN | 4,045 | $530K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 8,766 | $146K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 3,541 | $1.9M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 8,766 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,766 | — |
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.