| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD., STE 100 SAN JOSE, CA 95119 | THE UNION LABOR LIFE INSURANCE COMPANY | $59K | — | $59K | 5.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | THE UNION LABOR LIFE INSURANCE COMPANY | $59K | — | $59K | 5.00% |
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD., #100 SAN JOSE, CA 95119 | DELTA DENTAL OF CALIFORNIA | $48K | — | $48K | 5.00% |
| 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 | $446K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $217K |
| MILLER, KAPLAN, ARASE, & CO., LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | 4123 LANKERSHIM BLVD NORTH HOLLYWOOD, CA 91602 | $38K |
| AMERICAN HEALTH HOLDING NONE | Accounting (including auditing) Service code 10 | 7400 W CAMPUS ROAD, F-510 NEW ALBANY, OH 43054 | $26K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL EIN 94-2576729 NONE | Legal Service code 29 | 369 PINE STREET SUITE 800 SAN FRANCISCO, CA 941043323 | $24K |
| SALTZMAN & JOHNSON NONE | Legal Service code 29 | 44 MONTGOMERY STREET, #2110 SAN FRANCISCO, CA 94104 | $22K |
| 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 | $14K |
| COMPLIANCE AUDIT SERVICE NONE | Accounting (including auditing) Service code 10 | 719 ADAM STREET MOUNTAIN HOUSE, CA 95391 | $8K |
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 | 1,831 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 101 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,932 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 2,543 | $10.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,743 | $959K |
| Vision | VISION SERVICE PLAN | 1,862 | $169K |
| Life insurance | SUN LIFE AND HEALTH INSURANCE COMPANY | 1,712 | $23K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,030 | $1.2M |
| Other | SUN LIFE AND HEALTH INSURANCE COMPANY | 1,712 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,543 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.