| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 701 B STREET, STE 600 SAN DIEGO, CA 92101 | UNITEDHEALTHCARE INSURANCE COMPANY | $131K | — | $131K | 2.99% |
| KAERCHER INSURANCE AGENCY INC.3 Filed as: KAERCHER INSURANCE AGENCY, INC | 1800 CENTURY PARK EAST, STE 400 LOS ANGELES, CA 90067 | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | $34K | — | $34K | 2.01% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 701 B STREET, STE 600 SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN, INC. | $45K | — | $45K | 3.18% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 701 B STREET, STE 600 SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN, INC. | $28K | — | $28K | 3.31% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 701 B STREET, STE 600 SAN DIEGO, CA 92101 | EYEMED VISION CARE (FIDELITY) | $15K | — | $15K | 10.89% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 701 B STREET, STE 600 SAN DIEGO, CA 92101 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $5K | — | $5K | 5.08% |
| JOHN ENOMOTO3 Filed as: JOHN DELEE | 737 BISHOP STREET, STE 1200 HONOLULU, HI 96813 | HAWAII MEDICAL ASSURANCE ASSOCIATION | $2K | — | $2K | 4.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 69420 HARRISBURG, PA 17106 | $57K |
| HELIX ELECTRIC INC. EIN 33-0124909 EMPLOYER/PLAN ADMIN | Plan Administrator Service code 14 | PO BOX 85298 SAN DIEGO, CA 92186 | $49K |
| LEVITZACKS EIN 95-3159181 TAX RETURN PREP | Accounting (including auditing) Service code 10 | 701 B STREET, SUITE 1300 SAN DIEGO, CA 92101 | $16K |
| MOSS ADAMS EIN 95-0189318 AUDITORS | Accounting (including auditing) Service code 10 | 4747 EXECUTIVE DRIVE, STE 1300 SAN DIEGO, CA 92121 | $9K |
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 | 1,659 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,659 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 691 | $8.4M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 618 | $100K |
| Vision | EYEMED VISION CARE (FIDELITY) | 0 | $135K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | 472 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 691 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.