| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN | — | — | $0 | 0.00% |
| IMG5 | 2960 NORTH MERIDIAN ST INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 0.29% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $859 | $859 | 0.05% |
| CARL W. ROMSTADT3 | 8300 POLO CROSSE AVENEUE SACRAMENTO, CA 95829 | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | $920 | — | $920 | 1.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $12.0M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $4.3M |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $962K |
| HEALTH MANAGEMENT CONCEPTS NONE | Direct payment from the plan; Contract Administrator Service code 13 | 140 INTRACOSTAL POINTE DR. STE 301 JUPITER, FL 33477 | $634K |
| DELTA DENTAL EIN 94-1461312 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $629K |
| HORIZON ACTUARIAL SERVICES, LLC NONE | Direct payment from the plan; Actuarial Service code 11 | 1040 CROWN POINTE PARKWAY, STE 560 ATLANTA, GA 30338 | $538K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $519K |
| SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $467K |
| ELIXIR EIN 90-1011712 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $463K |
| INVESCO GLOBAL EIN 58-1707262 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 101 CALIFORNIA ST., SUITE 1800 SAN FRANCISCO, CA 94111 | $447K |
| ACTIVE RADAR EIN 81-0843133 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $363K |
| 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 | $335K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $334K |
| UFCW LOCAL 5 EIN 20-8028546 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $276K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $269K |
| MCCRACKEN, STEMMERMAN & HOLSBERRY EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | — | $228K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $205K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $174K |
| HGK ASSET MGMT EIN 52-1296988 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $138K |
| PREMIER ACCESS INSURANCE EIN 91-1857813 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $133K |
| 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 | $126K |
| NEW ENGLAND PENSION CONSULTANTS EIN 04-2927339 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $87K |
| PODIATRY PLAN EIN 94-2864053 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $84K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $69K |
| UFCW LOCAL 648 EIN 94-0525380 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $49K |
| BOEHM & ASSOCIATES | Contract Administrator; Direct payment from the plan Service code 13 | — | $48K |
| CIGNA EIN 59-1031071 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $19K |
| NORTHERN TRUST EIN 36-1561860 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $16K |
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 | 28,256 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 28,256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 331 | $47K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 83,465 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 83,465 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.