| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON3 | 378 VINTAGE PARK DRIVE FOSTER CITY, CA 94404 | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | $1K | — | $1K | 10.00% |
| TANG CHUNG MAN3 | 4203 TOBIN CIRCLE SANTA CLARA, CA 95054 | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | $355 | — | $355 | 2.50% |
| WESTERN DENTAL SERVICES, INC.3 | 530 S. MAIN STREET ORANGE, CA 33006 | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | $213 | — | $213 | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRUCKER HUSS EIN 94-2776854 NONE | Other fees; Legal; Direct payment from the plan Service code 29 | — | $98K |
| MICHELLE CHANG EIN 94-1243666 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $88K |
| WILHELMINA ALDAY EIN 94-1243666 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $82K |
| MICHAEL JACYNA EIN 94-1243666 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| VIRGINIA BRIGGS EIN 94-1243666 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $71K |
| PATRICIA MARTIN EIN 94-1243666 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $64K |
| RAEL AND LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general); Actuarial; Insurance agents and brokers Service code 11 | — | $56K |
| SIU PACIFIC DISTRICT SUPPLEMENTAL EIN 94-1431246 COMMON TRUSTEE | Direct payment from the plan; Contract Administrator Service code 13 | — | $47K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $32K |
| DODGE AND COX EIN 94-1441976 NONE | Investment management fees paid directly by plan; Soft dollars commissions; Investment management; Direct payment from the plan Service code 28 | — | $20K |
| ZENITH ADMINISTRATOR EIN 95-2934127 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $19K |
| UNION BANK EIN 94-0304228 NONE | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $17K |
| US BANK NONE | Direct payment from the plan; Investment management fees paid indirectly by plan; Custodial (securities) Service code 19 | 221 SOUTH FIGUEROA ST., SUITE 210 LOS ANGELES, CA 90012 | $14K |
| BLEAKPOINT SALES NONE | Other services; Direct payment from the plan Service code 49 | 741 VIA CASITAS GREENBRAE, CA 94904 | $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 | 629 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 338 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 967 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 6 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 258 | $6.3M |
| Dental(4 contracts, 4 carriers) | DELTA DENTAL OF CALIFORNIA | 400 | $138K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF LOUISIANA | 7 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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.