| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NLI INSURANCE AGENCY, INC.3 Filed as: NLI INSURANCE AGENCY, INC | — | UNITEDHEALTHCARE OF CALIFORNIA | $28K | — | $28K | 1.50% |
| ANTHEM INSURANCE COMPANIES, INC.0 Filed as: ANTHEM INSURANCE COMPANIES | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 462044903 | FOUR EVER LIFE INS CO | $5K | $2K | $7K | 12.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CLAIMS PROCESSOR | Other fees; Other services; Direct payment from the plan; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $7.4M |
| AON HEWITT BENEFITS ADMINISTRATOR | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | 100 HALF DAY ROAD LINCOLNSHIRE, IL 60069 | $1.2M |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $552K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $195K |
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Direct payment from the plan; Claims processing Service code 12 | — | $165K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACTOR | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $139K |
| CONEXIS EIN 20-0198855 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $87K |
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 | 11,259 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,529 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 204 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 15,788 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | GROUP HEALTH COOPERATIVE | 161 | $1.4M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 21,744 | $829K |
| Vision | VISION SERVICE PLAN | 13,848 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 21,744 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.