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| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $823K |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $244K |
| SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $93K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $64K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $62K |
| DELTA DENTAL EIN 94-1461312 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $42K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $42K |
| QUEST DIAGNOSTICS NONE | Other services; Direct payment from the plan Service code 49 | 500 PLAZA DRIVE SECAUCUS, NJ 07094 | $35K |
| HEALTH MANAGEMENT CONCEPTS EIN 75-3189468 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $35K |
| ELIXIR EIN 90-1011712 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $30K |
| MCCRACKEN, STEMMERMAN & HOLLSBERRY EIN 94-1709555 NONE | Direct payment from the plan; Legal Service code 29 | — | $25K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $17K |
| UFCW UNION LOCAL 8 EIN 94-0801845 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $14K |
| CYPRESS DENTAL EIN 68-0441908 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $13K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $6K |
| PODIATRY PLAN EIN 82-2040110 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $5K |
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 | 1,686 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,686 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 1,087 | $5.1M |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 30 | $3K |
| Life insurance(2 contracts) | PRUDENTIAL | 4,577 | $148K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY | 1,269 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,577 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.