| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD. #318 BURLINGAME, CA 94010 | METLIFE | $715K | $198K | $913K | 1.82% |
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD. #318 BURLINGAME, CA 94010 | HARTFORD LIFE & ACCIDENT | $187K | $176K | $362K | 1.94% |
| DISABILITY MGMT ALT, LLC5 Filed as: DISABILITY MGMT | 9 FARM SPRINGS RD. 1ST FL FARMINGTON, CT 06032 | HARTFORD LIFE & ACCIDENT | — | $17K | $17K | 0.09% |
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD. #318 BURLINGAME, CA 94010 | RELIASTAR | $360K | — | $360K | 2.00% |
| CCHI3 | MONTGOMERY ST. #650 SAN FRANCISCO, CA 94111 | RELIASTAR | — | $15K | $15K | 0.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UHC EIN 36-2739571 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $21.9M |
| METLIFE EIN 13-5581829 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $1.5M |
| VSP CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $616K |
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 | 50,877 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 609 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 51,491 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | KAISER - CALIFORNIA | 3,014 | $43.9M |
| Life insurance | METLIFE | 50,877 | $50.3M |
| Short-term disability(2 contracts, 2 carriers) | HARTFORD LIFE & ACCIDENT | 50,877 | $18.7M |
| Long-term disability | HARTFORD LIFE & ACCIDENT | 50,877 | $18.7M |
| Prescription drug(5 contracts, 5 carriers) | KAISER - CALIFORNIA | 3,014 | $43.9M |
| Stop-loss / reinsurancereinsurance | RELIASTAR | 43,759 | $18.0M |
| Other(2 contracts, 2 carriers) | METLIFE | 50,877 | $50.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 50,877 | — |
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."
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.