| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $426K |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Direct payment from the plan; Claims processing Service code 12 | 3401 N. CENTRE LAKE DR. 400 ONTARIO, CA 91761 | $118K |
| HORIZON ACTUARIAL SERVICES, LLC NONE | Direct payment from the plan; Actuarial Service code 11 | 420 EXCHANGE, SUITE 260 IRVINE, CA 92602 | $93K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $54K |
| SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $44K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $24K |
| HEALTH MANAGEMENT CONCEPTS NONE | Claims processing; Direct payment from the plan Service code 12 | 140 INTRACOASTAL POINTE DR. STE 301 JUPITER, FL 33477 | $21K |
| MCCRACKEN, STEMMERMAN & HOLLSBERRY EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | — | $19K |
| PREMIER ACCESS DENTAL NONE | Claims processing; Direct payment from the plan Service code 12 | 8890 CAL CENTER DRIVE SACRAMENTO, CA 95826 | $18K |
| ENVISION RX NONE | Claims processing; Direct payment from the plan Service code 12 | 2181 EAST AURORA ROAD, SUITE 201 TWINSBURG, OH 44087 | $17K |
| VAVRINEK, TRINE, DAY & CO., LLP EIN 95-2648289 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $14K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $9K |
| BENEFIT AND RISK MANAGEMENT SERVICE NONE | Direct payment from the plan; Consulting (general) Service code 16 | 80 IRON POINT CIRCLE, SUITE 200 FOLSOM, CA 95630 | $9K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $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 | 1,305 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,305 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 496 | $2.2M |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 48 | $6K |
| Life insurance(2 contracts) | PRUDENTIAL | 2,473 | $62K |
| Stop-loss / reinsurancereinsurance | BLUE SHIELD OF CALIFORNIA | 842 | $397K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,473 | — |
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.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.