| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | WESTPORT INSURANCE CORPORATION | $30K | — | $30K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Copying and duplicating; Direct payment from the plan; Contract Administrator Service code 13 | — | $462K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $118K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | — | $90K |
| BEESON, TAYER & BODINE, APC EIN 94-3126136 NONE | Legal; Direct payment from the plan Service code 29 | — | $80K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $48K |
| MANAGED HEALTH NETWORK EIN 95-4146179 NONE | Direct payment from the plan; Other services; Claims processing Service code 12 | — | $42K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $33K |
| CITY NATIONAL BANK EIN 95-1780067 NONE | Direct payment from the plan; Custodial (other than securities); Other services Service code 18 | — | $22K |
| TEAMSTERS ASSISTANCE PROGRAM EIN 68-0048516 NONE | Other services; Direct payment from the plan Service code 49 | — | $22K |
| ALAN BILLER AND ASSOCIATES EIN 94-2854958 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $20K |
| HEALTH MANAGEMENT SYSTEMS, INC. NONE | Direct payment from the plan; Other services Service code 49 | 5615 HIGH POINT DRIVE IRVING, TX 75038 | $15K |
| DON HOPKINS TRUSTEE | Trustee (individual); Named fiduciary; Direct payment from the plan Service code 20 | 221 MAIN STREET, SUITE 250 SAN FRANCISCO, CA 94105 | $11K |
| OPTUM RX, INC. EIN 33-0441200 NONE | Other fees; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $10K |
| CORPORATE MAIL SERVICE LLC EIN 46-2336568 NONE | Direct payment from the plan; Other services Service code 49 | — | $10K |
| IRON MOUNTAIN EIN 04-3038590 NONE | Direct payment from the plan; Other services Service code 49 | — | $8K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $7K |
| MARTY CRANDALL TRUSTEE | Direct payment from the plan; Trustee (individual); Named fiduciary Service code 20 | 221 MAIN STREET, SUITE 250 SAN FRANCISCO, CA 94105 | $7K |
| TOPAZ PRINTING EIN 55-2279858 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $6K |
| LOU VALLETTA NONE | Trustee (individual); Named fiduciary; Direct payment from the plan Service code 20 | 221 MAIN STREET, SUITE 250 SAN FRANCISCO, CA 94105 | $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 | 1,039 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 710 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,749 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,879 | $10.2M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 91 | $329K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 1,452 | $147K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION | 552 | $597K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 1,452 | $147K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,879 | — |
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."
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.