| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $12K | $12K | 0.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $11.3M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $4.6M |
| HEALTHWAYS EIN 62-1216689 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.0M |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1300 HANCOCK STREET REDWOOD CITY, CA 94063 | $874K |
| HEALTH MANAGEMENT CONCEPTS NONE | Contract Administrator; Direct payment from the plan Service code 13 | 140 INTRACOSTAL POINTE DR. STE 301 JUPITER, FL 33477 | $747K |
| HEMMING MORSE EIN 30-0702322 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $700K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | 2029 CENTURY PARK EAST STE 3500 LOS ANGELES, CA 90067 | $621K |
| DELTA DENTAL EIN 94-1461312 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $544K |
| SAFEWAY HEALTH PARTY IN INTEREST | Contract Administrator; Direct payment from the plan Service code 13 | 5918 STONERIDGE MALL ROAD PLEASANTON, CA 94588 | $459K |
| CATAMARAN EIN 11-2581812 NONE | Direct payment from the plan; Claims processing Service code 12 | 2441 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | $448K |
| HS TECHNOLOGY EIN 27-1818792 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $427K |
| PREMIER ACCESS INSURANCE EIN 91-1857813 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 8890 CAL CENTER DRIVE SACRAMENTO, CA 95826 | $420K |
| SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO, CA 94104 | $373K |
| BENEFIT AND RISK MANAGEMENT SERVICE NONE | Consulting (general); Direct payment from the plan Service code 16 | 80 IRON POINT CIRCLE, SUITE 200 FOLSOM, CA 95630 | $337K |
| CREWS MACQUARRIE ASSOC EIN 38-3647875 NONE | Direct payment from the plan; Actuarial Service code 11 | 2855 MICHELLE DRIVE IRVINE, CA 92606 | $324K |
| VISION SERVICE PLAN EIN 23-7316300 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $306K |
| DAVIS COWELL & BOWE EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | 595 MARKET STREET SUITE 1400 SAN FRANCISCO, CA 94105 | $277K |
| UFCW LOCAL 5 EIN 20-8028546 PARTY IN INTEREST | Direct payment from the plan; Contract Administrator Service code 13 | 240 S MARKET ST SAN JOSE, CA 95113 | $245K |
| UFCW LOCAL 8 EIN 94-0801845 PARTY IN INTEREST | Contract Administrator; Direct payment from the plan Service code 13 | 2200 PROFESSIONAL DR ROSEVILLE, CA 95661 | $198K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $141K |
| PODIATRY PLAN EIN 94-2864053 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $120K |
| ANALYTIC INVESTORS, LLC NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $116K |
| BIO IQ BIOMETRIC TEST NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1222 STATE STREET SUITE 200 SANTA BARBARA, CA 93101 | $98K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $89K |
| PIMCO | Securities brokerage commissions and fees; Contract Administrator; Direct payment from the plan Service code 13 | — | $80K |
| HGK ASSET MGMT EIN 52-1296988 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 525 WASHINGTON BLVD STE 2000 JERSEY CITY, NJ 07310 | $62K |
| NEW ENGLAND PENSION CONSULTANTS EIN 04-2927339 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | ONE MAIN STREET CAMBRIDGE, MA 02142 | $43K |
| NORTHERN TRUST EIN 36-2723087 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $16K |
| KAISER ACTION STEPS EIN 94-1340523 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $15K |
| OPTUMINSIGHT NONE | Direct payment from the plan; Contract Administrator Service code 13 | PO BOX 292377 NASHVILLE, TN 37229 | $10K |
| AMERICAN HEALTH HOLDINGS EIN 31-1368946 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 | 33,426 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 33,426 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LIBERTY DENTAL | 581 | $91K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 136,807 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136,807 | — |
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.