| 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 | $107K | $63K | $170K | 7.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX, INC. EIN 33-0441200 NONE | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $8.0M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Contract Administrator Service code 13 | — | $1.7M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Other services; Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $606K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Claims processing Service code 12 | — | $378K |
| NATIONAL COMPLIANCE SERVICES EIN 77-0547083 NONE | Accounting (including auditing) Service code 10 | — | $293K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $111K |
| WHEELER SONOMA PRINTING EIN 20-8452680 NONE | Copying and duplicating; Distribution (12b-1) fees Service code 36 | — | $108K |
| AMERICAN REALTY ADVISORS EIN 33-0123114 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $87K |
| RICHARD J. ROMANSKI NONE | Legal; Direct payment from the plan Service code 29 | 3182 CAMPUS DR STE 346 SAN MATEO, CA 94403 | $85K |
| HSTECHNOLOGY SOLUTIONS, INC. EIN 27-1818792 NONE | Other services Service code 49 | — | $71K |
| CHARTWELL INVESTMENT PARTNERS LLC EIN 36-4776242 NONE | Investment management fees paid directly by plan Service code 51 | — | $69K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $53K |
| HUMAN BEHAVIOR ASSOCIATES EIN 94-3413007 NONE | Direct payment from the plan; Other services Service code 49 | — | $52K |
| WEDGE CAPITAL MANAGEMENT LLP EIN 56-1557450 NONE | Investment management fees paid directly by plan Service code 51 | — | $51K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Investment advisory (plan); Consulting (general) Service code 16 | — | $50K |
| WYLIE, MCBRIDE, PLATTEN & RENNER EIN 94-2633731 NONE | Legal Service code 29 | — | $41K |
| WELOCALIZE INC. NONE | Copying and duplicating Service code 36 | 241 EAST 4TH ST STE 207 FREDERICK, MD 21701 | $32K |
| TIM BREKKE NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $30K |
| GEORGE HERNANDEZ NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $29K |
| CHARLES GILCHRIST 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 | $26K |
| GOLDEN TRIANGLE SPECIALTY NETWORK EIN 26-0821440 NONE | Other services; Direct payment from the plan Service code 49 | — | $26K |
| JIM BEARD NONE | Trustee (individual) Service code 20 | 5 THOMAS MELLON CIR STE 111 SAN FRANCISCO, CA 94134 | $24K |
| STATE STREET BANK & TRUST CO EIN 23-7404790 NONE | Trustee (directed); Other fees Service code 25 | — | $14K |
| FREMONT BANK EIN 94-1569024 NONE | Other services Service code 49 | — | $14K |
| MARK SHARWOOD NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $11K |
| H. JIM EDWARDS NONE | Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $10K |
| STEPHEN HORN INSURANCE SERVICES 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 | 9,411 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 9,411 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 7,634 | $78.6M |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 5,006 | $2.9M |
| Vision | VISION SERVICE PLAN | 4,671 | $598K |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 9,101 | $148K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 3,364 | $2.1M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 9,101 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,101 | — |
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.