| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MENTAL HEALTH ADVISORY GROUP LLC3 | PO BOX 399 ALAMEDA, CA 94501 | HEALTH NET LIFE | $29K | — | $29K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSOC. THIRD PARTY ADMINISTRATORS EIN 94-3187938 NONE | Copying and duplicating; Contract Administrator Service code 13 | — | $1.4M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Claims processing; Other services Service code 12 | — | $288K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing) Service code 10 | — | $247K |
| DELTA DENTAL EIN 94-1461312 NONE | Claims processing Service code 12 | — | $216K |
| SEGAL COMPANY EIN 94-1503999 NONE | Consulting (general); Actuarial Service code 11 | — | $163K |
| SALTZMAN & JOHNSON EIN 94-2376174 NONE | Legal Service code 29 | — | $76K |
| TRUST BENEFITS TECHNOLOGIES EIN 68-0457700 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $56K |
| MCMORGAN AND COMPANY EIN 52-2334338 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $29K |
| EVOLUTION1, INC. EIN 06-1593514 NONE | Claims processing Service code 12 | — | $26K |
| FREMONT BANK EIN 94-1569025 NONE | Custodial (other than securities) Service code 18 | — | $15K |
| OPTUMRX, INC. EIN 33-0441200 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $14K |
| AABCO PRINTING EIN 94-1553665 NONE | Copying and duplicating Service code 36 | — | $14K |
| SUBURBAN PRESS EIN 94-2477030 NONE | Copying and duplicating Service code 36 | — | $12K |
| IRON MOUNTAIN EIN 33-0795048 NONE | Other services Service code 49 | — | $6K |
| INTELLI-SERVICES EIN 56-2293081 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $5K |
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 | 3,194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 5,766 | $31.4M |
| Dental(4 contracts, 4 carriers) | DELTA DENTAL OF CALIFORNIA | 756 | $905K |
| Vision | VISION SERVICE PLAN | 3,406 | $738K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 3,454 | $364K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,038 | $915K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 3,454 | $364K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,766 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.