| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | THE UNION LABOR LIFE INSURANCE COPMANY | $3K | — | $3K | 1.01% |
| NONE | — | AMALGAMATED LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT ADMINISTRATION CORPORATION EIN 94-1646941 NONE | Contract Administrator Service code 13 | — | $39K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $38K |
| TRANSWESTERN INSURANCE ADMIN EIN 77-0118024 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $32K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $25K |
| LAW OFFICE OF MICHAEL E MOSS EIN 91-1882299 NONE | Legal; Direct payment from the plan Service code 29 | 201 SPEAR ST., SUITE 1100 SAN FRANCISCO, CA 94105 | $20K |
| HEALTHSMART - INTERPLAN NONE | Direct payment from the plan; Insurance services Service code 23 | 222 LAS COLINAS BLVD. W STE. 500 IRVING, TX 75039 | $13K |
| SEGAL MARCO ADVISORS EIN 13-2626110 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $9K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL | Legal; Direct payment from the plan Service code 29 | 369 PINE ST., STE 800 SAN FRANCISCO, CA 94104 | $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 | 144 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 152 | $5K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COPMANY | 151 | $272K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.