| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $12K | — | $12K | 5.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC | PO BOX 845052 LOS ANGELES, CA 900845052 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $10K | — | $10K | 4.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Contract Administrator Service code 13 | — | $161K |
| KRAW & KRAW LEGAL GROUP EIN 94-3085124 NONE | Legal Service code 29 | — | $59K |
| ANTHEM BLUE CROSS EIN 95-3760980 NONE | Insurance services Service code 23 | — | $36K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing) Service code 10 | — | $31K |
| U.A. LOCAL 355 EIN 68-0189344 PLAN SPONSOR | Contract Administrator Service code 13 | — | $30K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $29K |
| DELTA DENTAL EIN 94-1461312 NONE | Claims processing Service code 12 | — | $23K |
| CITY NATIONAL BANK EIN 95-1780067 NONE | Custodial (other than securities) Service code 18 | — | $18K |
| MCMORGAN COMPANY EIN 52-2334338 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $11K |
| TOPAZ PRINTING NONE | Copying and duplicating Service code 36 | 24191 MACHADO CT. HAYWARD, CA 94541 | $8K |
| LINDA ROSSMAN EIN 94-3254224 TRUSTEE | Trustee (individual); Named fiduciary Service code 20 | — | $7K |
| MIGUEL INIGUEZ EIN 94-3254224 TRUSTEE | Trustee (individual); Named fiduciary Service code 20 | — | $6K |
| GARY ANDREWS EIN 94-3254224 TRUSTEE | Trustee (individual); Named fiduciary Service code 20 | — | $6K |
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 | 251 | 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) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 232 | $22K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 552 | $8K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 168 | $231K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 552 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 552 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.