| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. | 2125 YGNACIO VALLEY RD SUITE 200 WALNUT CREEK, CA 94598 | BLUE CROSS OF CALIFORNIA | $201K | $17K | $218K | 15.80% |
| XL BENEFIT INSURANCE SERVICES3 | 10471 GRANT LINE ROAD SUITE 100 ELK GROVE, CA 95624 | PAN-AMERICAN LIFE INSURANCE COMPANY | $54K | $54K | $109K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SIP INSURANCE SERVICES EIN 81-5191759 BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | 790 THE CITY DRIVE S SUITE 210 ORANGE, CA 92868 | $412K |
| HEALTHCOMP EIN 77-0385729 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | PO BOX 45018 FRESNO, CA 93718 | $312K |
| ANTHEM BLUE CROSS LIFE EIN 95-4331852 PPO VENDOR | Direct payment from the plan; Other fees Service code 50 | PO BOX 60007 LOS ANGELES, CA 90060 | $230K |
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 | 1,060 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,060 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,804 | $2.1M |
| Dental(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,804 | $2.1M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,804 | $735K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,804 | $735K |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,804 | $735K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,804 | $735K |
| Prescription drug | CVS PHARMACY, INC | 1,804 | $0 |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 695 | $1.1M |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,804 | $735K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,804 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.