| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $27K | — | $27K | 10.00% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 35 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | RELIASTAR LIFE INSURANCE COMPANY | $38K | — | $38K | 15.33% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | CONCERN EAP | $2K | — | $2K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE N/A | Contract Administrator; Direct payment from the plan Service code 13 | 9700 HEALTH CARE LANE MINNETONKA, MN 55343 | $367K |
| EDGEWOOD PARTNERS INSURANCE CENTER N/A | Other commissions; Direct payment from the plan Service code 50 | 135 MAIN STREET, 21ST FLOOR SAN FRANCISCO, CA 94105 | $71K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $56K |
| BUSINESS SOLVER N/A | Contract Administrator Service code 13 | 1025 ASHWORTH ROAD WEST DES MOINES, IA 50265 | $50K |
| DELTA DENTAL N/A | Direct payment from the plan; Contract Administrator Service code 13 | 100 FIRST STREET SAN FRANCISCO, CA 94105 | $48K |
| INTERREMEDY INSURANCE SERVICES N/A | Contract Administrator; Direct payment from the plan Service code 13 | 315 MONTGOMERY STREET SUITE 900 SAN FRANCISCO, CA 94104 | $38K |
| VISION SERVICE PLAN EIN 94-1632821 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $20K |
| MATRIX ABSENCE MANAGEMENT N/A | Direct payment from the plan; Contract Administrator Service code 13 | 2421 W. PEORIA AVE, SUITE 200 PHOENIX, AZ 85029 | $15K |
| THE LARKIN COMPANY N/A | Contract Administrator; Direct payment from the plan Service code 13 | 2350 MISSION COLLEGE BLVD, SUITE 39 SANTA CLARA, CA 95054 | $13K |
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 | 662 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 73 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 735 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 186 | $973K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1 | $0 |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 2,169 | $250K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 642 | $271K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 186 | $929K |
| Other(5 contracts, 4 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 2,169 | $324K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,169 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.