| 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 | $132K | — | $132K | 5.26% |
| 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 | Plan Administrator; Direct payment from the plan Service code 14 | — | $2.0M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other services; Direct payment from the plan Service code 12 | — | $768K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $395K |
| NATIONAL COMPLIANCE SERVICES EIN 77-0547083 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $300K |
| AMERICAN REALTY ADVISORS EIN 33-0123114 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $118K |
| CHARTWELL INVESTMENT PARTNERS LLC EIN 36-4776242 | Named fiduciary; Investment management fees paid directly by plan; Investment management Service code 28 | — | $110K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $106K |
| RICHARD J. ROMANSKI EIN 04-1328449 NONE | Legal; Direct payment from the plan Service code 29 | — | $85K |
| WHEELER SONOMA PRINTING EIN 20-8452680 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $83K |
| WEDGE CAPITAL MANAGEMENT LLP EIN 56-1557450 NONE | Investment management fees paid directly by plan Service code 51 | — | $76K |
| HUMAN BEHAVIOR ASSOCIATES EIN 94-3413007 NONE | Other services; Direct payment from the plan Service code 49 | — | $59K |
| BEESON, TAYER & BODINE APC EIN 94-3126136 NONE | Legal; Direct payment from the plan Service code 29 | — | $54K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Consulting (general); Direct payment from the plan; Investment advisory (plan) Service code 16 | — | $50K |
| GEORGE HERNANDEZ TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $41K |
| TIM BREKKE TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $33K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $27K |
| RAY NANN TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $24K |
| CHARLES GILCHRIST TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBSANE, CA 94005 | $24K |
| JIM BEARD TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $24K |
| H. JIM EDWARDS TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $15K |
| HSTECHNOLOGY SOLUTIONS, INC. EIN 27-1818792 NONE | Direct payment from the plan; Other services Service code 49 | — | $13K |
| STEPHEN HORN INSURANCE SERVICES EIN 94-3249244 NONE | Insurance brokerage commissions and fees; Direct payment from the plan Service code 50 | — | $8K |
| US BANK NATIONAL ASSOCIATION EIN 31-0841368 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $7K |
| FREEMONT BANK EIN 94-1569024 NONE | Direct payment from the plan; Other services Service code 49 | — | $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 | 10,789 | 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) | 10,789 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 7,548 | $87.3M |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 6,154 | $2.3M |
| Vision | VISION SERVICE PLAN | 7,932 | $1.0M |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 10,370 | $148K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 4,314 | $2.5M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 10,370 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,370 | — |
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.