| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1600 HARBOR BAY PKWY, SUITE 200 ALAMEDA, CA 94502 | $538K |
| BLUE CROSS OF CALIFORNIA EIN 95-3760980 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $350K |
| KAUFMANN & GOBLE EIN 94-2614826 NONE | Actuarial; Direct payment from the plan Service code 11 | 160 SANTA CLARA STREET STE 1550 SAN JOSE, CA 95113 | $158K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $118K |
| COSTCO RX NONE | Plan Administrator; Direct payment from the plan Service code 14 | 999 LAKE DRIVE ISSAQUASH, WA 98027 | $97K |
| PIPE TRADE DC #36 PENSION PLAN EIN 94-6082956 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $71K |
| CRYSTAL CLEAR RX EIN 27-3009945 NONE | Claims processing; Direct payment from the plan Service code 12 | 19753 EAST PIKES PEAK AVE, STE G103 PARKER, CO 80138 | $46K |
| MATRIX TRUST COMPANY EIN 75-3182674 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $38K |
| HEALTH CARE EVALUATIONS EIN 94-1701048 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $38K |
| VAVRINEK, TRINE, DAY & CO., LLP EIN 95-2648289 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 1900 S. NORFOLK ST., SUITE 225 SAN MATEO, CA 94403 | $28K |
| UA LOCAL 246 EIN 94-0775057 PARTY IN INTEREST | Direct payment from the plan; Plan Administrator Service code 14 | — | $19K |
| UA LOCAL 442 EIN 94-1015453 PARTY IN INTEREST | Plan Administrator; Direct payment from the plan Service code 14 | — | $19K |
| UA LOCAL 62 EIN 77-0376399 SPONSOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $17K |
| THE MOSS LAW FIRM EIN 46-5416498 NONE | Legal; Direct payment from the plan Service code 29 | 201 SPEAR STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | $17K |
| UA LOCAL 228 EIN 94-1493708 PARTY IN INTEREST | Direct payment from the plan; Plan Administrator Service code 14 | — | $12K |
| US BANK EIN 31-0841368 NONE | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $12K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $6K |
| TUCKER, CHIU, HABESHA, & WARD NONE | Legal; Direct payment from the plan Service code 29 | 642 POLLASKV AVE. CLOVIS, CA 93612 | $6K |
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 | 1,274 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 425 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,699 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | NEWPORT DENTAL PLAN | 63 | $54K |
| Vision(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 3,493 | $208K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE OF CALIFORNIA SAN FRANCISCO | 1,699 | $534K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,493 | — |
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.