| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALTERNATIVE RISK SOLUTIONS LLC3 | 101 2ND ST SUITE 100 PETALUMA, CA 94952 | SYMETRA LIFE INSURANCE COMPANY | $0 | $203K | $203K | 6.00% |
| ALTERNATIVE RISK SOLUTIONS LLC3 | 101 2ND ST SUITE 100 PETALUMA, CA 94952 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $2K | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $3.6M |
| SMITH CONSULTING, LLC EIN 81-0579832 CONSULTING | Consulting (general) Service code 16 | — | $312K |
| LIBERTY DENTAL PLAN OF NEVADA, INC. EIN 26-0424586 CLAIMS PROCESSING | Other services; Claims processing Service code 12 | — | $273K |
| HARMONY PHC EIN 04-3290453 SERVICE PROVIDER | Other services; Contract Administrator Service code 13 | — | $248K |
| CVS HEALTH EIN 05-0340626 PHARMACY BENEFITS MANAGER | Float revenue; Other fees; Direct payment from the plan; Claims processing Service code 12 | — | $238K |
| SUN LIFE ASSURANCE OF CANADA EIN 38-1082080 CLAIMS PROCESSING | Claims processing Service code 12 | — | $200K |
| VISION SERVICE PLAN EIN 23-7089668 CLAIMS PROCESSING | Claims processing Service code 12 | — | $80K |
| HEALTHLINX, LLC EIN 87-0660214 AUDITOR | Accounting (including auditing) Service code 10 | — | $45K |
| THE WELLNESS GROUP LLC EIN 26-4394907 OTHER SERVICES | Other services Service code 49 | — | $23K |
| WIPFLI LLP EIN 39-0758449 OUTSIDE AUDITOR | Accounting (including auditing) Service code 10 | — | $6K |
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 | 11,118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 11,153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 350 | $21K |
| Dental | LIBERTY DENTAL PLAN OF NEVADA, INC. | 2,414 | $716K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 9,560 | $2.0M |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,098 | $1.4M |
| Prescription drug | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | 348 | $3.3M |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 9,235 | $0 |
| Other(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 9,560 | $5.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,560 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.