| 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 | — | — | $0 | 0.00% |
| CARL W. ROMSTADT3 | 8300 POLO CROSSE AVENEUE SACRAMENTO, CA 95829 | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | $1K | — | $1K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 SALARIED ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $10.0M |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $3.3M |
| QUEST DIAGNOSTIC EIN 20-1908041 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $837K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $766K |
| MEDEXPERT INTERNATIONAL INC EIN 94-3360248 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $724K |
| DELTA DENTAL EIN 94-1461312 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $706K |
| HEALTH MANAGEMENT CONCEPTS EIN 75-3189468 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $528K |
| SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $438K |
| ELIXIR EIN 90-1011712 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $416K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $360K |
| ACTIVE RADAR EIN 81-0843133 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $301K |
| VISION SERVICE PLAN EIN 23-7316300 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $263K |
| UFCW LOCAL 5 EIN 20-8028546 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $262K |
| SEYFARTH & SHAW EIN 36-2152202 NONE | Direct payment from the plan; Legal Service code 29 | — | $259K |
| PHARMACY BENEFIT SOLUTIONS EIN 47-0866096 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $190K |
| MCCRACKEN, STEMMERMAN & HOLSBERRY EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | — | $188K |
| UFCW LOCAL 8 EIN 94-0801845 SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $184K |
| ULLICO INVESTMENT ADVISORS INC. EIN 52-6435649 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $168K |
| NEW ENGLAND PENSION CONSULTANTS EIN 26-1429809 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $106K |
| HGK ASSET MGMT EIN 52-1296988 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $92K |
| JACE MARKETING SOLUTIONS EIN 27-2412041 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $74K |
| PODIATRY PLAN EIN 94-2864053 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $70K |
| LORD ABBETT EIN 13-5620131 NONE | Investment management; Investment management fees paid indirectly by plan Service code 28 | — | $58K |
| UFCW LOCAL 648 EIN 94-0525380 SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $45K |
| NORTHERN TRUST EIN 36-2723087 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $41K |
| LABCORP EIN 83-3697312 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $40K |
| CIGNA EIN 59-1031071 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $37K |
| COMMUNITY HOSPITAL OF THE MONTEREY NONE | Direct payment from the plan; Other services Service code 49 | 23625 HOLMAN HWY MONTEREY, CA 93940 | $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 | 25,895 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 25,895 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC | 406 | $55K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 76,814 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 76,814 | — |
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.