| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INUSRANCE SERVICES, INC. | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | PAN AMERICAN LIFE INSURANCE COMPANY | $10K | — | $10K | 3.09% |
| BENEFITS PLANNING SERVICE3 Filed as: BENEFITS PLANNING SV | SUITE 105 1200 QUAIL STREET NEWPORT BEACH, CA 92660 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| BENEFITS PLANNING SERVICE3 | 1200 QUAIL ST SUITE 105 NEWPORT BEACH, CA 92660 | VISION SERVICE PLAN | $2K | — | $2K | 10.00% |
| BENEFITS PLANNING SERVICE3 | 1200 QUAIL ST SUITE 105 NEWPORT BEACH, CA 92660 | UDC DENTAL OF CALIFORNIA, INC. | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFITS PLANNING SERV EIN 33-0421912 BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $99K |
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $58K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Other fees; Direct payment from the plan Service code 50 | — | $55K |
| UNION SECURITY INS. CO. EIN 81-0170040 ADMIN SERVICES- DENTAL | Other fees; Claims processing Service code 12 | — | $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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UDC DENTAL OF CALIFORNIA, INC. | 76 | $20K |
| Vision | VISION SERVICE PLAN | 140 | $25K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 339 | $73K |
| Stop-loss / reinsurancereinsurance | PAN AMERICAN LIFE INSURANCE COMPANY | 187 | $321K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 339 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 339 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.