| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS ADMINISTRATORS EIN 38-2383171 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 7180 KOLL CENTER PARKWAY PLEASANTON, CA 94566 | $436K |
| BLUE CROSS OF CALIFORNIA EIN 95-3760980 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $176K |
| KAUFMANN & GOBLE EIN 94-2614826 NONE | Direct payment from the plan; Actuarial Service code 11 | 160 SANTA CLARA STREET STE 1550 SAN JOSE, CA 95113 | $131K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $84K |
| HEMMING MORSE EIN 30-0702322 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $74K |
| PIPE TRADE DC 36 PENSION PLAN EIN 94-6082956 PARTY IN INTEREST | Direct payment from the plan; Plan Administrator Service code 14 | — | $58K |
| ENVISION EIN 90-1011712 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $37K |
| US BANK EIN 31-0841368 NONE | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $32K |
| THE MOSS LAW FIRM NONE | Legal; Direct payment from the plan Service code 29 | 5260 NORTH PALM AVE. SUITE 205 FRESNO, CA 93704 | $32K |
| HEALTH CARE EVALUATIONS EIN 94-1701048 NONE | Direct payment from the plan; Plan Administrator Service code 14 | 100 WEST OLD WILSON BRIDGE RD FLR 3 WORTHINGTON, OH 43085 | $28K |
| TUCKER, CHIU, HEBESHA, & WARD NONE | Legal; Direct payment from the plan Service code 29 | 642 POLLASKV AVE. CLOVIS, CA 93612 | $28K |
| UA LOCAL 442 EIN 94-1015453 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $15K |
| UA LOCAL 246 EIN 94-0775057 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $14K |
| TRUVERIS EIN 27-4345686 NONE | Other services; Direct payment from the plan Service code 49 | — | $13K |
| UA LOCAL 228 EIN 94-1493708 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $9K |
| UA LOCAL 62 EIN 77-0376399 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $8K |
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 | 914 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 477 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,391 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | NEWPORT DENTAL PLAN | 37 | $31K |
| Vision(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,242 | $188K |
| Life insurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 746 | $342K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 746 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,242 | — |
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.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.