| 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 | $19K | — | $19K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA FUND ADMINISTRATORS, LLC EIN 45-2636626 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Claims processing; Participant communication Service code 12 | — | $232K |
| 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 | — | $79K |
| KRAW LAW GROUP EIN 32-0465891 NONE | Legal Service code 29 | — | $57K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $42K |
| 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 | Claims processing; Direct payment from the plan Service code 12 | — | $30K |
| SOUTHERN SIERRAS CHAPTER, NECA EIN 95-2265383 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Copying and duplicating; Direct payment from the plan Service code 15 | — | $7K |
| J. RICHARD HOGUE NONE | Actuarial; Direct payment from the plan 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 | 573 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 185 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 758 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,071 | $4.6M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 497 | $76K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 653 | $182K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 775 | $35K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 406 | $389K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 775 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,071 | — |
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.