| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| INTERREMEDY INSURANCE SERVICES Filed as: INTERREMEDY INSURANCE SERVICES LLC | 315 MONTGOMERY ST, SUITE 900 SAN FRANCISCO, CA 94101 | BERKSHIRE HATHAWAY | $899 | — | $899 | 4.05% |
| NONE | — | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $89K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| BLUE SHIELD EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $9K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Direct payment from the plan; Legal Service code 29 | — | $8K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 86 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 86 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 26 | $120K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY | 36 | $3K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKSHIRE HATHAWAY | 36 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 36 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.