| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENICIA, CA 945102950 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $35K | — | $35K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX EIN 33-0441200 NONE | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $846K |
| RAEL AND LETSON EIN 94-1701048 NONE | Consulting (pension); Actuarial Service code 11 | — | $86K |
| CHRIS MCDANIEL EMPLOYEE OF AFFILIATED TR | Plan Administrator Service code 14 | 5841 NEWMAN COURT SACRAMENTO, CA 95819 | $73K |
| UNITED CONCORDIA EIN 25-1687586 NONE | Claims processing Service code 12 | — | $56K |
| CALIBRE NETWORKS SOLUTIONS NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 1317 HELFORD LANE CARMEL, IN 46032 | $54K |
| ALISA MUELLER EMPLOYEE OF AFFILIATED TR | Plan Administrator Service code 14 | 5841 NEWMAN COURT SACRAMENTO, CA 95819 | $53K |
| BELINDA HIBBARD EMPLOYEE OF AFFILIATED TR | Plan Administrator Service code 14 | 5841 NEWMAN COURT SACRAMENTO, CA 95819 | $53K |
| CONNIE HIBBARD EMPLOYEE OF AFFILIATED TR | Plan Administrator Service code 14 | 5841 NEWMAN COURT SACRAMENTO, CA 95819 | $52K |
| BRAD BERNEL EMPLOYEE OF AFFILIATED TR | Plan Administrator Service code 14 | 5841 NEWMAN COURT SACRAMENTO, CA 95819 | $51K |
| INNOVATIVE SOFTWARE SOLUTIONS INC NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 3000 S LENOLA RD MAPLE SHADE, NJ 080521613 | $45K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $33K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing) Service code 10 | — | $22K |
| ISLIP & CO. EIN 68-0344156 NONE | Accounting (including auditing) Service code 10 | — | $22K |
| UNION BANK EIN 94-0304228 NONE | Other services; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $18K |
| KRAW LAW GROUP, APC EIN 32-0465891 NONE | Legal Service code 29 | — | $13K |
| VICTOR BERTOLANI NONE | Legal Service code 29 | 1731 J ST STE 250 SACRAMENTO, CA 95811 | $8K |
| MESVISION EIN 95-4354242 NONE | Claims processing Service code 12 | — | $8K |
| MERRILL LYNCH PIERCE FENNER & SMITH EIN 13-5674085 NONE | Distribution (12b-1) fees; Sub-transfer agency fees Service code 60 | — | $0 |
| STEPHEN HORN INSURANCE SERVICES EIN 94-3249244 NONE | Insurance brokerage commissions and fees Service code 53 | — | $0 |
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 | 714 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 219 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 933 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS, INC | 1,224 | $6.9M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 107 | $78K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMP | 741 | $60K |
| Stop-loss / reinsurancereinsurance | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | 423 | $694K |
| Other | THE UNION LABOR LIFE INSURANCE COMP | 741 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,224 | — |
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.