| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | BLUE SHIELD OF CALIFORNIA | — | — | $0 | 0.00% |
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | 0.00% |
| NONE | — | HEALTH NET | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | NEWPORT DENTAL PLAN | — | — | $0 | 0.00% |
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | 0.00% |
| NONE | — | NEWPORT DENTAL PLAN | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW & EMPLOYERS TRUST, LLC EIN 26-0048379 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $118K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $104K |
| THE SEGAL CO. EIN 94-1503999 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $60K |
| WEINBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal; Direct payment from the plan Service code 29 | — | $44K |
| US BANK EIN 31-0841368 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $14K |
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 | 220 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 80 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | HEALTH NET | 24 | $205K |
| Dental(4 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 455 | $181K |
| Vision | HEALTH NET | 22 | $152K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 8 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 455 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.