| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: ONESOURCE STOPLOSS INS. MARKETING | 9290 W STOCKTON BLVD STE 104 ELK GROVE, CA 95758 | HCC LIFE INSURANCE COMPANY | $16K | — | $16K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA FUND ADMINISTRATORS, LLC EIN 45-2636626 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $207K |
| CORNWELL & BALDWIN EIN 32-0453228 NONE | Legal; Direct payment from the plan Service code 29 | — | $78K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $66K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $48K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 NONE | Direct payment from the plan; Insurance services; 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 |
| MUFG UNION BANK, N.A. EIN 94-0304228 NONE | Direct payment from the plan; Account maintenance fees; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $8K |
| SOUTHERN SIERRAS CHAPTER, NECA EIN 95-2265383 NONE | Direct payment from the plan; Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees Service code 15 | — | $7K |
| J RICHARD HOGUE FSA NONE | Direct payment from the plan; Actuarial Service code 11 | 10423 RUBIO AVE GRANADA HILLS, CA 91344 | $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 | 553 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 195 | 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) | 748 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,179 | $4.6M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 583 | $86K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 638 | $176K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 745 | $34K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 754 | $321K |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 745 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,179 | — |
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.