| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OPTIMA HEALTHCARE INSURANCE SERVICE3 | 9229 SIERRA COLLEGE BLVD ROSEVILLE, CA 95661 | PARTNERRE AMERICAN INSURANCE COMPANY | $70K | — | $70K | 10.23% |
| HEALTHCARE PROVIDER RESOURCES, INC.3 | 258 SCENIC VIEW TERRACE PEGRAM, TX 37143 | PARTNERRE AMERICAN INSURANCE COMPANY | $23K | — | $23K | 3.27% |
| STOP LOSS INSURANCE SERVICES, INC.3 | PO BOX 845052 LOS ANGELES, CA 900845052 | PARTNERRE AMERICAN INSURANCE COMPANY | $10K | — | $10K | 1.50% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FL SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $21K | $4K | $25K | 14.16% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FL SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $2K | $11K | 13.09% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FL SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $2K | $11K | 14.17% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FL SAN FRANCISCO, CA 94105 | VISION SERVICE PLAN | $3K | — | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ADVANTEK BENEFIT ADMINISTRATORS EIN 77-0382381 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | P.O. BOX 45007 FRESNO, CA 93718 | $214K |
| BLUE CROSS LIFE & HEALTH INSURANCE NONE | Other services Service code 49 | DEPARTMENT 5812 LOS ANGELES, CA 90074 | $171K |
| RX - US CARE NONE | Other services Service code 49 | P.O. BOX 4328 TORRANCE, CA 90510 | $29K |
| KEENAN & ASSOCIATES EIN 95-2798626 NONE | Other services Service code 49 | P.O. BOX 4328 TORRANCE, CA 90510 | $25K |
| MULTIPLAN, INC. EIN 13-3068979 NONE | Other services Service code 49 | 115 FIFTH AVENUE NEW YORK, NY 10003 | $23K |
| VISION SERVICE PLAN EIN 94-1632821 CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $19K |
| THE DENTAL PPA EIN 26-0603616 NONE | Other services Service code 49 | PMB 261 4719 QUAIL LAKES DR, STE G STOCKTON, CA 95207 | $15K |
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 | 1,018 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,018 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 1,026 | $0 |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,149 | $157K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,149 | $83K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,149 | $256K |
| Stop-loss / reinsurancereinsurance | PARTNERRE AMERICAN INSURANCE COMPANY | 795 | $687K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,149 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,149 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.