| 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 | $167K | — | $167K | 5.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX, INC. EIN 33-0441200 NONE | Float revenue; Direct payment from the plan; Other fees; Claims processing Service code 12 | — | $9.2M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $2.4M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Float revenue; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator Service code 12 | — | $997K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $331K |
| NATIONAL COMPLIANCE SERVICES EIN 77-0547083 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $300K |
| HMC HEALTHWORKS NONE | Direct payment from the plan; Other services Service code 49 | 140 INTRACOASTAL POINTE DR STE 301 JUPITER, FL 33477 | $185K |
| AMERICAN REALTY ADVISORS EIN 33-0123114 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $166K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $149K |
| CHARTWELL INVESTMENT PARTNERS, LLC EIN 36-4776242 NONE | Investment management fees paid directly by plan; Named fiduciary; Investment management Service code 28 | — | $108K |
| WEDGE CAPITAL MANAGEMENT LLP EIN 56-1557450 NONE | Investment management fees paid directly by plan Service code 51 | — | $86K |
| RICHARD J. ROMANSKI EIN 04-1328449 NONE | Legal; Direct payment from the plan Service code 29 | — | $85K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $73K |
| KP LLC EIN 93-0563572 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $69K |
| HUMAN BEHAVIOR ASSOCIATES EIN 94-3413007 NONE | Other services; Direct payment from the plan Service code 49 | — | $67K |
| BEESON, TAYLOR, & BODINE APC EIN 94-3126136 NONE | Legal; Direct payment from the plan Service code 29 | — | $66K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Direct payment from the plan; Investment advisory (plan); Consulting (general) Service code 16 | — | $50K |
| HARMAN PRESS NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 6840 VINELAND AVE NORTH HOLLYWOOD, CA 91605 | $25K |
| TIM BREKKE TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $25K |
| GEORGE HERNANDEZ TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 500 BRISBANE, CA 94005 | $24K |
| CHARLES GILCHRIST TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, 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 |
| RYAN NAAN TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $24K |
| WEST COAST MAILERS NONE | Direct payment from the plan; Other services Service code 49 | 5630 BORWICK AVE SOUTH GATE, CA 90280 | $19K |
| FREMONT BANK EIN 94-1569024 NONE | Other services; Direct payment from the plan Service code 49 | — | $15K |
| KAYE SMITH NONE | Copying and duplicating; Direct payment from the plan Service code 36 | PO BOX 956 RENTON, WA 98057 | $12K |
| STEPHEN HORN INSURANCE SERVICES EIN 94-3249244 NONE | Insurance brokerage commissions and fees Service code 53 | — | $10K |
| H. JIM EDWARDS TRUSTEE | Plan Administrator; Trustee (individual); Direct payment from the plan Service code 14 | 1000 MARINA BLVD STE 400 BRISBANE, CA 94005 | $9K |
| US BANK NATIONAL ASSOCIATION EIN 31-0841368 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $9K |
| KATHERINE LOH GRAPHIC DESIGN NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 200 VALLEY DR BRISBANE, CA 94005 | $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 | 12,433 | 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) | 12,433 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 7,601 | $96.7M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 302 | $4.1M |
| Vision | VISION SERVICE PLAN | 8,724 | $1.1M |
| Life insurance | UNION LABOR LIFE INSURANCE COMPANY | 12,748 | $168K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 5,758 | $3.2M |
| Other | UNION LABOR LIFE INSURANCE COMPANY | 12,748 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 12,748 | — |
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.