| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMAGE FINANCIAL & INSURANCE SERV3 Filed as: IMAGE FINANCIAL | 550 CALIFORNIA ST SUITE 130 SAN FRANCISCO, CA 94104 | UNIMERICA LIFE INSURANCE COMPANY | $30K | — | $30K | 10.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | UNIMERICA LIFE INSURANCE COMPANY | $15K | — | $15K | 5.00% |
| INAGE FINANCIAL & INSURANCE SVCS3 | 225 BUSH ST SUITE 1820 SAN FRANCISCO, CA 94104 | PRUDENTIAL INSURANCE CO OF AMERICA | $15K | — | $15K | 18.41% |
| IMAGE FINANCIAL & INS SERVS OF N CA3 | 565 COMMERCIAL ST 4TH FLOOR SAN FRANCISCO, CA 94111 | UNITED OF OMAHA LIFE INS CO | $4K | — | $4K | 9.50% |
| IMAGE FINANCIAL & INS SERVS OF N CA3 | 565 COMMERCIAL ST 4TH FLOOR SAN FRANCISCO, CA 94111 | UNITED OF OMAHA LIFE INS CO | $6K | — | $6K | 15.00% |
| IMAGE FINANCIAL & INSURANCE SERV3 | 565 COMMERICIAL ST 4TH FLOOR SAN FRANCISCO, CA 94111 | CLAREMONT EAP | $483 | — | $483 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMIN | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $115K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Other fees; Direct payment from the plan Service code 50 | — | $80K |
| IMAGE FINANCIAL & INS. SERV. EIN 94-3101411 BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $54K |
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 | 230 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | PRUDENTIAL INSURANCE CO OF AMERICA | 220 | $102K |
| Short-term disability | UNITED OF OMAHA LIFE INS CO | 223 | $43K |
| Long-term disability | UNITED OF OMAHA LIFE INS CO | 222 | $44K |
| Stop-loss / reinsurancereinsurance | UNIMERICA LIFE INSURANCE COMPANY | 227 | $296K |
| Other | CLAREMONT EAP | 225 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.