| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD., SUITE #100 SAN JOSE, CA 95119 | THE UNION LABOR LIFE INSURANCE COMPANY | $173K | — | $173K | 10.00% |
| 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 | $87K | — | $87K | 5.00% |
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD., #100 SAN JOSE, CA 95119 | DELTA DENTAL OF CALIFORNIA | $56K | — | $56K | 5.00% |
| STEPHEN CHELBAY COMPANY3 | 6800 SANTA TERESA BLVD, SUITE #100 SAN JOSE, CA 95119 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 3.38% |
| 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 | $503K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $273K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL EIN 94-2576729 NONE | Legal Service code 29 | 369 PINE STREET SUITE 800 SAN FRANCISCO, CA 941043323 | $55K |
| SALTZMAN & JOHNSON NONE | Legal Service code 29 | 1141 HARBOR BAY PARKWAY, SUITE 100 ALAMEDA, CA 94502 | $28K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 NONE | Other services Service code 49 | 7400 W CAMPUS ROAD, F-510 NEW ALBANY, OH 43054 | $21K |
| STEPHEN CHELBAY CO. EIN 94-1750014 NONE | Consulting (general) Service code 16 | P.O. BOX 5057 SAN JOSE, CA 95128 | $18K |
| MILLER, KAPLAN, ARASE, & CO., LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | 4123 LANKERSHIM BLVD NORTH HOLLYWOOD, CA 91602 | $15K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE SUITE 780 FOSTER CITY, CA 94404 | $14K |
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 | 1,919 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 94 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,013 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 2,686 | $11.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 2,257 | $1.1M |
| Vision | VISION SERVICE PLAN | 2,049 | $159K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,027 | $138K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,178 | $1.7M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,027 | $138K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,686 | — |
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."
No prospect flags tripped on this filing.