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.
Multiple-employer welfare arrangement. It has its own regulatory and compliance rules.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
Broker: Hub International Insurance Service HMOHealth | HMOHealth | |
HealthRx | HealthRx | |
DentalVisionLifeOther | DentalVisionLifeOther | |
STD | STD | |
Health | Health |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 7 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 | 1,175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,177 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 353 | $5.4M |
| Dental | GUARDIAN | 1,145 | $297K |
| Vision | GUARDIAN | 1,145 | $297K |
| Life insurance | GUARDIAN | 1,145 | $297K |
| Short-term disability | MUTUAL OF OMAHA | 353 | $102K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 296 | $4.0M |
| Other | GUARDIAN | 1,145 | $297K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,145 | - |
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: Aetna Life Insurance Co. |
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL EIN 33-0315047 N/A | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $551K |
| FRINGE BENEFIT GROUP, INC. N/A | Contract Administrator; Direct payment from the plan; Insurance agents and brokers Service code 13 | 11910 ANDERSON MILL ROAD, STE 401 AUSTIN, TX 78726 | $322K |
| BAKER TILLY US LLP EIN 39-0859910 N/A | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $58K |
| ABC-NCC EIN 92-3378739 PLAN SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $50K |
| RR DONNELLEY COMPANY N/A | Copying and duplicating; Direct payment from the plan Service code 36 | 955 GATEWAY CENTER WAY SAN DIEGO, CA 92102 | $41K |
| GAROFOLO & RAMSDELL, LLP N/A | Legal; Direct payment from the plan Service code 29 | 3443 GOLDEN GATE WAY H LAFAYETTE, CA 94549 | $34K |
| CHARLES SCHWAB N/A | Investment management; Investment management fees paid directly by plan Service code 28 | 6200 STONEBRIDGE MAIL ROAD PLEASANTON, CA 94588 | $7K |
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