| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 W 34TH ST NEW YORK, NY 10001 | UNION LABOR LIFE INSURANCE COMPANY | $235 | — | $235 | 1.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSOCIATED THIRD PARTY ADMIN. EIN 94-3187938 NONE | Contract Administrator Service code 13 | — | $498K |
| ANTHEM BLUE CROSS OF CA EIN 95-4331852 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $205K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Claims processing Service code 12 | — | $129K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Consulting (general) Service code 16 | — | $119K |
| OPERATING ENGINEERS LOCAL 3 EIN 94-0577785 PARTY IN INTEREST | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $84K |
| DENVER MANAGEMENT ADVISORS INC EIN 55-0888767 NONE | Consulting (general) Service code 16 | — | $48K |
| ENGINEERS PUBLISHING NONE | Copying and duplicating Service code 36 | 1620 S LOOP RD ALAMEDA, CA 94502 | $37K |
| PHARMACY BENEFIT SOLUTIONS, INC NONE | Consulting (general) Service code 16 | 7610 AUBURN BLVD #8 CITRUS HEIGHTS, CA 95610 | $36K |
| WEINBERG, ROGER, AND ROSENFELD EIN 94-2458080 NONE | Legal Service code 29 | — | $27K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $26K |
| INCOME RESEARCH & MANAGEMENT EIN 04-2955404 NONE | Investment management Service code 28 | — | $21K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing Service code 12 | — | $20K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-1645862 NONE | Investment advisory (plan) Service code 27 | — | $16K |
| ASSISTANCE RECOVERY PROGRAM EIN 94-3042622 NONE | Direct payment from the plan; Other services Service code 49 | — | $11K |
| OPTUM RX EIN 33-0441200 NONE | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $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 | 1,107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 139 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,246 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 947 | $6.0M |
| Life insurance(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 1,477 | $1.0M |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 1,076 | $1.0M |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 1,076 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,477 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.