| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | BERKSHIRE HATHAWAY | — | — | $0 | 0.00% |
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| NONE | — | RELIASTAR LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| THE SEGAL COMPANY3 | 333 WEST 34TH ST NEW YORK, NY 100012402 | THE UNION LABOR LIFE INSURANCE COMPANY | $377 | — | $377 | 5.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 1141 HARBOR BAY PARKWAY, SUITE 100 ALAMEDA, CA 94502 | $354K |
| ANTHEM BLUE CROSS OF CA EIN 95-4331852 NONE | Float revenue; Contract Administrator; Direct payment from the plan; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $183K |
| MIKE MCCALL EIN 94-2567865 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $157K |
| SEGAL COMPANY EIN 94-1503999 NONE | Consulting (general); Direct payment from the plan; Insurance brokerage commissions and fees; Other commissions Service code 16 | — | $142K |
| ZELIS EIN 86-1040704 NONE | Other fees; Direct payment from the plan Service code 50 | — | $116K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $66K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $66K |
| PHARMACY BENEFIT SOLUTIONS NONE | Consulting (general); Direct payment from the plan Service code 16 | 8421 AUBURN BLVD STE 280 CITRUS HEIGHTS, CA 95610 | $61K |
| WEINBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal; Direct payment from the plan Service code 29 | — | $54K |
| OPTUM RX EIN 33-0441200 NONE | Direct payment from the plan; Float revenue; Other fees; Claims processing Service code 12 | — | $41K |
| EIDE BAILLY, LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $35K |
| DENVER MANAGEMENT ADVISORS INC EIN 55-0888767 NONE | Consulting (general); Investment management fees paid directly by plan Service code 16 | — | $22K |
| CHARTWELL INVESTMENT PARTNERS EIN 36-4776242 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $21K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-1645862 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $15K |
| INCOME RESEARCH & MANAGEMENT EIN 04-2955404 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $15K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $13K |
| AUSTRIS RUNGIS EIN 94-2567865 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $10K |
| OPERATING ENGINEERS LOCAL 3 EIN 94-0577785 PARTY IN INTEREST | Employee (plan); Direct payment from the plan Service code 30 | — | $10K |
| GREGORY RAMIREZ EIN 94-2567865 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $8K |
| STEPHEN HORN INSURANCE EIN 94-3249244 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $5K |
| BOEHM AND ASSOCIATES EIN 94-2361175 NONE | Direct payment from the plan; Other fees Service code 50 | — | $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 | 819 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 117 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 936 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 114 | $663K |
| Life insurance(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 711 | $23K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY | 936 | $1.2M |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 711 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 936 | — |
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.