| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINSTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $7.1M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $315K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $314K |
| SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $228K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $200K |
| UFCW LOCAL 5 EIN 20-8028546 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $186K |
| VISION SERVICE PLAN EIN 23-7316300 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $143K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $131K |
| DELTA DENTAL EIN 94-1461312 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $127K |
| PART D ADVISORS, INC. EIN 20-2595200 NONE | Direct payment from the plan; Other services Service code 49 | — | $101K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $96K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $95K |
| ENVISION RX EIN 90-1011712 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $72K |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $38K |
| ACTIVE RADAR EIN 81-0843133 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $38K |
| HGK ASSET MANAGEMENT EIN 52-1296988 NONE | Investment management; Direct payment from the plan Service code 28 | — | $35K |
| SAV RX NONE | Direct payment from the plan; Other services Service code 49 | 224 NORTH PARK AVENUE FREMONT, NE 68025 | $33K |
| UFCW LOCAL 648 EIN 94-0525380 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $32K |
| NEW ENGLAND PENSION CONSULTANTS EIN 26-1429809 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $17K |
| MCCRAKEN, STEMMERMAN & HOLSBERRY EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | — | $15K |
| COBAPAYER EXPRESS NONE | Other fees; Direct payment from the plan Service code 50 | 7500 SECURITY BOULEVARD BALTIMORE, MD 212441850 | $12K |
| CIGNA DENTAL EIN 59-1031071 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $9K |
| PODIATRY PLAN EIN 94-2864053 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $7K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13,661 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 13,661 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 10,486 | $23.8M |
| Life insurance | PRUDENTIAL | 434 | $10K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 10,486 | $23.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,486 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.