Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingBroker comp is under 1% of premium on a plan over $1M. The plan may have no broker or pay a flat fee. Consultants can pitch it.
Premium per covered life exceeds 2x the peer median for this NAICS and size cohort. The plan has rich benefits or a bad rate.
The filing reports zero broker compensation on a plan over 100 participants. The plan likely buys direct or does not report its broker. Give it a call.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
HMO | HMO | |
Broker: None HealthRx | HealthRx | |
Broker: None HMO | HMO | |
Life | Life |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 4 contracts with Pro. Pro is free for 7 days and then costs $49 a month.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13,380 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 13,380 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 10,111 | $24.3M |
| Life insurance | PRUDENTIAL | 398 | $8K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 10,111 | $24.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,111 | - |
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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
| Broker | Commissions |
|---|---|
None Carrier: Blue Shield of California | |
None Carrier: United Health Care |
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINSTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $4.3M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $311K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $288K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $254K |
| SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $208K |
| SOLIDARITUS EIN 87-3068107 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $158K |
| VISION SERVICE PLAN EIN 23-7316300 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $140K |
| DELTA DENTAL EIN 94-1461312 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $135K |
| UFCW LOCAL 5 EIN 20-8028546 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $91K |
| ELIXIR RX SOLUTIONS EIN 90-1011712 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $88K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $85K |
| HUDSON EDGE INVESTMENT PARTNERS EIN 52-1296988 NONE | Investment management fees paid indirectly by plan; Investment management Service code 28 | — | $76K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $66K |
| PRUDENTIAL GROUP INSURANCE EIN 22-1211670 NONE | Direct payment from the plan; Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $65K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $49K |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $39K |
| SSDC SERVICES CORPORATION EIN 38-3357459 NONE | Direct payment from the plan; Other services Service code 49 | — | $36K |
| SAV RX NONE | Other services; Direct payment from the plan Service code 49 | 224 NORTH PARK AVENUE FREMONT, NE 68025 | $25K |
| NEW ENGLAND PENSION CONSULTANTS EIN 26-1429809 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $24K |
| UFCW LOCAL 648 EIN 94-0525380 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $17K |
| CIGNA DENTAL EIN 59-1031071 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $10K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
1 contact
11 filings · 2015 to 2025