| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: ONESOURCE STOPLOSS INS. MARKETING | 9245 LAGUNA SPRINGS DR STE 320 ELK GROVE, CA 957587991 | HCC LIFE INSURANCE COMPANY | $12K | — | $12K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA FUND ADMINISTRATORS, LLC EIN 45-2636626 NONE | Participant communication; Contract Administrator; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $212K |
| CORNWELL, BRADY & BALDWIN EIN 32-0453228 NONE | Legal; Direct payment from the plan Service code 29 | — | $72K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Direct payment from the plan; Float revenue Service code 12 | — | $52K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $30K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $27K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $25K |
| DELTA HEALTH SYSTEMS EIN 94-2353289 NONE | Other services Service code 49 | — | $8K |
| SOUTHERN SIERRAS CHAPTER, NECA EIN 95-2265383 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Copying and duplicating Service code 15 | — | $7K |
| MUFG UNION BANK, N.A. EIN 94-0304228 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan; Account maintenance fees Service code 21 | — | $7K |
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 | 574 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 197 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 771 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,224 | $5.5M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 626 | $94K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 623 | $154K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 697 | $75K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 1,224 | $5.4M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 363 | $246K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 697 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,224 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.