| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| INTEREMEDY INSURANCE SERVICES LLC3 | 3115 MONTGOMERY ST, SUITE 900 SAN FRANCISCO, CA 94101 | BERKSHIRE HATHAWAY | $58K | — | $58K | 5.00% |
| NONE | — | PRUDENTIAL | — | — | $0 | 0.00% |
| NONE | — | PRUDENTIAL | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $803K |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | 3401 N. CENTRE LAKE DR. 400 ONTARIO, CA 91761 | $260K |
| SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $90K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $89K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $68K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Actuarial; Direct payment from the plan Service code 11 | 420 EXCHANGE, SUITE 260 IRVINE, CA 92602 | $62K |
| DELTA DENTAL EIN 94-1461312 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $40K |
| HEALTH MANAGEMENT CONCEPTS EIN 75-3189468 NONE | Direct payment from the plan; Claims processing Service code 12 | 140 INTRACOASTAL POINTE DR. STE 301 JUPITER, FL 33477 | $39K |
| MCCRACKEN, STEMMERMAN & HOLLSBERRY EIN 94-1709555 NONE | Direct payment from the plan; Legal Service code 29 | — | $36K |
| ELIXIR EIN 90-1011712 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $30K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $18K |
| CYPRESS DENTAL EIN 68-0441908 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $14K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $13K |
| QUEST DIAGNOSTICS NONE | Direct payment from the plan; Other services Service code 49 | 500 PLAZA DRIVE SECAUCUS, NJ 07094 | $13K |
| BENEFIT AND RISK MANAGEMENT SERVICE EIN 37-1611268 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $8K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $6K |
| PODIATRY PLAN EIN 82-2040110 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $6K |
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 | 1,775 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,775 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 1,050 | $3.9M |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 27 | $3K |
| Life insurance(2 contracts) | PRUDENTIAL | 4,363 | $155K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY | 1,322 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,363 | — |
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."
No prospect flags tripped on this filing.