Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingBroker comp is under 1% of premium on a plan over $1M. The plan may have no broker or pay a flat fee. Consultants can pitch it.
Premium per covered life exceeds 2x the peer median for this NAICS and size cohort. The plan has rich benefits or a bad rate.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
HMO | HMO | |
HealthHMO | HealthHMO | |
Broker: Lee Family Insurance Services, Inc. HealthRx | HealthRx | |
Dental | Dental | |
Dental | Dental | |
Vision | Vision | |
LifeOther | LifeOther |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 19 contracts with Pro. Pro is free for 7 days and then costs $49 a month.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 5,913 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 186 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,099 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 881 | $13.0M |
| Dental(4 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 4,808 | $3.1M |
| Vision(4 contracts) | VISION SERVICE PLAN | 3,262 | $416K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,089 | $193K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 881 | $6.3M |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,089 | $193K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,705 | - |
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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
| Broker | Commissions |
|---|---|
Carrier: Blue Shield of California - California Physicians' Service |
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DMC INSURANCE ADMINISTRATORS EIN 94-3115552 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.9M |
| WITHUMSMITH+BROWN, PC EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $224K |
| SIMPLE THERAPY, INC. EIN 46-5571185 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $145K |
| TEAMSTERS ASSISTANCE PROGRAM EIN 68-0048516 NONE | Other services; Direct payment from the plan Service code 49 | — | $128K |
| WEINBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal; Direct payment from the plan Service code 29 | — | $94K |
| NORTHWEST PLAN SERVICES EIN 91-2090931 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $83K |
| MAMMINI COMPANY INC EIN 47-0879697 NONE | Investment advisory (plan); Investment management; Direct payment from the plan Service code 27 | — | $65K |
| PRESTIGE PRINTING EIN 83-2018068 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $51K |
| JAMES BEARD EIN 94-3138272 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $12K |
| EFREN ALARCON EIN 94-3138272 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $11K |
| ELITE ADMINISTRATION & INSURANCE GR EIN 36-2238689 NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $11K |
| DON E GARCIA EIN 94-3138272 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $11K |
| COMMONWEALTH EQUITY SERVICES, LLC EIN 04-2675571 NONE | Float revenue; Custodial (securities); Direct payment from the plan Service code 19 | — | $9K |
| BRUCE HEID EIN 94-3138272 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $6K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
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11 filings · 2015 to 2025