| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | — | NATIONAL UNION FIRE INSURANCE COMPANY OF PA | $6K | $0 | $6K | 10.00% |
| WOODRUFF-SAWYER & CO3 | 50 CALIFORNIA ST FL 12 SAN FRANCISCO, CA 941114646 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.04% |
| WOODRUFF-SAWYER & CO3 Filed as: WOODRUFFF SAWYER & CO | 717 17TH ST STE 1540 DENVER, CO 802023314 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $899 | $6K | 16.77% |
| WOODRUFF-SAWYER & CO3 | 717 17TH ST STE 1540 DENVER, CO 802023314 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $387 | $387 | 2.95% |
| WOODRUFF-SAWYER & CO3 | 717 17TH ST STE 1540 DENVER, CO 802023314 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $147 | $147 | 2.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WOODRUFF-SAWYER & CO EIN 94-1625126 BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | 50 CALIFORNIA STREET, FLOOR 12 SAN FRANCISCO, CA 94111 | $110K |
| POMCO, INC. EIN 15-0381548 PLAN SERVICE PROVIDER | Claims processing Service code 12 | — | $107K |
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 PLAN SERVICE PROVIDER | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $92K |
| AMERICAN HEALTH CARE EIN 68-0146015 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | 3850 ATHERTON ROAD ROCKLIN, CA 95765 | $90K |
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 | 337 | 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) | 337 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $0 |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $0 |
| Vision | VISION SERVICE PLAN | 227 | $41K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 230 | $48K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 51 | $6K |
| Prescription drug | AMERICAN HEALTH CARE | 337 | $0 |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | 337 | $721K |
| Other(3 contracts, 2 carriers) | NATIONAL UNION FIRE INSURANCE COMPANY OF PA | 337 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 337 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.