| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN | — | — | $0 | 0.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $11K | $11K | 0.64% |
| CARL W. ROMSTADT3 | 8300 POLO CROSSE AVENEUE SACRAMENTO, CA 95829 | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | $1K | — | $1K | 1.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $10.3M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $5.1M |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1300 HANCOCK STREET REDWOOD CITY, CA 94063 | $936K |
| HEALTH MANAGEMENT CONCEPTS NONE | Direct payment from the plan Service code 50 | 140 INTRACOSTAL POINTE DR. STE 301 JUPITER, FL 33477 | $690K |
| ENVISION RX NONE | Direct payment from the plan; Claims processing Service code 12 | 2181 EAST AURORA ROAD, SUITE 201 TWINSBURG, OH 44087 | $490K |
| INVESCO GLOBAL NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 101 CALIFORNIA ST., SUITE 1800 SAN FRANCISCO, CA 94111 | $474K |
| VAVRINEK, TRINE, DAY & CO., LLP EIN 95-2648289 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $469K |
| DELTA DENTAL EIN 94-1461312 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $449K |
| QUEST DIAGNOSTICS NONE | Direct payment from the plan; Contract Administrator Service code 13 | 2365 QUIMBY ROAD SAN JOSE, CA 95122 | $448K |
| SAFEWAY HEALTH PARTY IN INTEREST | Direct payment from the plan; Contract Administrator Service code 13 | 5918 STONERIDGE MALL ROAD PLEASANTON, CA 94588 | $428K |
| PREMIER ACCESS INSURANCE EIN 91-1857813 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 8890 CAL CENTER DRIVE SACRAMENTO, CA 95826 | $415K |
| 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 | $333K |
| SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO, CA 94104 | $318K |
| VISION SERVICE PLAN EIN 23-7316300 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $282K |
| MCCRACKEN, STEMMERMAN & HOLSBERRY EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | 595 MARKET STREET SUITE 1400 SAN FRANCISCO, CA 94105 | $280K |
| UFCW LOCAL 5 EIN 20-8028546 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | 240 S MARKET ST SAN JOSE, CA 95113 | $280K |
| CREWS MACQUARRIE ASSOC EIN 38-3647875 NONE | Direct payment from the plan; Actuarial Service code 11 | 2855 MICHELLE DRIVE IRVINE, CA 92606 | $254K |
| BENEFIT AND RISK MANAGEMENT SERVICE NONE | Direct payment from the plan; Consulting (general) Service code 16 | 80 IRON POINT CIRCLE, SUITE 200 FOLSOM, CA 95630 | $236K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | 2200 PROFESSIONAL DR ROSEVILLE, CA 95661 | $203K |
| ANALYTIC INVESTORS, LLC NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 555 WEST FIFTH STREET, 50TH FLOOR LOS ANGELES, CA 90013 | $185K |
| HGK ASSET MGMT EIN 52-1296988 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 525 WASHINGTON BLVD STE 2000 JERSEY CITY, NJ 07310 | $129K |
| HEALTHWAYS EIN 62-1216689 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $116K |
| PODIATRY PLAN EIN 94-2864053 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $100K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $78K |
| NEW ENGLAND PENSION CONSULTANTS EIN 04-2927339 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | ONE MAIN STREET CAMBRIDGE, MA 02142 | $76K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $65K |
| HORIZON ACTUARIAL SERVICES, LLC NONE | Direct payment from the plan; Actuarial Service code 11 | 1040 CROWN POINTE PARKWAY, STE 560 ATLANTA, GA 30338 | $53K |
| UFCW LOCAL 648 EIN 94-0525380 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $49K |
| KAISER ACTION STEPS EIN 94-1340523 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $34K |
| OPTUMINSIGHT NONE | Contract Administrator; Direct payment from the plan Service code 13 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $15K |
| HS TECHNOLOGY EIN 27-1818792 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $13K |
| NORTHERN TRUST EIN 36-2723087 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $13K |
| BOEHM & ASSOCIATES NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1701 HARBOR BAY PARKWAY, SUITE 100 ALAMEDA, CA 94502 | $9K |
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 | 30,438 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 30,438 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 371 | $58K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 83,824 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 83,824 | — |
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.