| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD STE 318 BURLINGAME, CA 940101919 | METLIFE | $741K | $397K | $1.1M | 2.34% |
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD STE 318 BURLINGAME, CA 94010 | HARTFORD LIFE & ACCIDENT | $222K | $183K | $405K | 1.82% |
| DISABILITY MGMT ALT, LLC5 Filed as: DISABILITY MGMT | 9 FARM SPRINGS RD. 1ST FL FARMINGTON, CT 06032 | HARTFORD LIFE & ACCIDENT | — | $0 | $0 | 0.00% |
| A.G. SIEBEN & ASSOCIATES3 | 800 AIRPORT BLVD STE 318 BURLINGAME, CA 94010 | RELIASTAR | $407K | — | $407K | 2.00% |
| CCHI3 | MONTGOMERY ST. #650 SAN FRANCISCO, CA 94111 | RELIASTAR | — | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UHC EIN 36-2739571 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $22.3M |
| METLIFE EIN 13-5581829 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $2.0M |
| VSP CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | — | $637K |
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 | 49,191 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,849 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 51,045 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 6 carriers) | KAISER - CALIFORNIA | 3,506 | $51.2M |
| Life insurance | METLIFE | 49,191 | $48.5M |
| Short-term disability(2 contracts, 2 carriers) | HARTFORD LIFE & ACCIDENT | 49,191 | $22.2M |
| Long-term disability | HARTFORD LIFE & ACCIDENT | 49,191 | $22.2M |
| Prescription drug(6 contracts, 6 carriers) | KAISER - CALIFORNIA | 3,506 | $51.2M |
| Stop-loss / reinsurancereinsurance | RELIASTAR | 43,144 | $20.3M |
| Other(2 contracts, 2 carriers) | METLIFE | 49,191 | $48.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 49,191 | — |
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."
No prospect flags tripped on this filing.