| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | AMALGAMATED LIFE INSURANCE COMPANY | $52K | — | $52K | 4.00% |
| STEPHEN CHELBAY COMPANY5 | 1120 SOUTH BASCOM AVENUE SAN JOSE, CA 95128 | AMALGAMATED LIFE INSURANCE COMPANY | — | $52K | $52K | 4.00% |
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD., #100 SAN JOSE, CA 95119 | DELTA DENTAL OF CALIFORNIA | $37K | — | $37K | 4.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED ADMINISTRATIVE SERVICES EIN 94-1749354 NONE | Contract Administrator Service code 13 | 6800 SANTA TERESA BOULEVARD SUITE 100 SAN JOSE, CA 95119 | $344K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $185K |
| MILLER, KAPLAN, ARASE, & CO., LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | 4123 LANKERSHIM BLVD NORTH HOLLYWOOD, CA 91602 | $57K |
| AMERICAN HEALTH HOLDING NONE | Other services Service code 49 | 7400 W CAMPUS ROAD, F-510 NEW ALBANY, OH 43054 | $23K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL EIN 94-2576729 NONE | Legal Service code 29 | 369 PINE STREET SUITE 800 SAN FRANCISCO, CA 941043323 | $19K |
| STEPHEN CHELBAY CO. EIN 94-1750014 NONE | Consulting (general) Service code 16 | P.O. BOX 5057 SAN JOSE, CA 95128 | $15K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE SUITE 780 FOSTER CITY, CA 94404 | $15K |
| COMPLIANCE AUDIT SERVICES NONE | Accounting (including auditing) Service code 10 | 719 ADAM STREET MOUNTAIN HOUSE, CA 95391 | $10K |
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 | 1,549 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 104 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,653 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 2,357 | $11.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,730 | $818K |
| Vision | VISION SERVICE PLAN | 1,615 | $153K |
| Life insurance | SUN LIFE AND HEALTH INSURANCE COMPANY | 1,657 | $90K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE INSURANCE COMPANY | 862 | $1.3M |
| Other | SUN LIFE AND HEALTH INSURANCE COMPANY | 1,657 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,357 | — |
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.