| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST STE G BENICIA, CA 94510 | THE UNION LABOR LIFE INSURANCE COMPANY | $21K | — | $21K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 NONE | Claims processing; Direct payment from the plan; Float revenue; Other fees Service code 12 | — | $1.2M |
| BENESYS, INC. EIN 38-2383171 NONE | Plan Administrator Service code 14 | — | $803K |
| ELECTRICAL INDUSTRY SERVICE CORP. EIN 94-3053367 RELATED ORGANIZATION | Plan Administrator Service code 14 | — | $143K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $56K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $43K |
| BENSINGER, DUPONT & ASSOCIATES EIN 36-3185080 NONE | Other services Service code 49 | — | $35K |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $30K |
| SAN JOAQUIN & CALAVERAS CTY JATC EIN 94-6411032 NONE | Other services Service code 49 | — | $21K |
| LEONARD CARDER, LLP EIN 94-2819269 NONE | Legal Service code 29 | — | $19K |
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 NONE | Investment advisory (plan) Service code 27 | — | $11K |
| DODGE & COX EIN 94-1441976 NONE | Investment management Service code 28 | — | $7K |
| COMERICA BANK EIN 42-1741646 NONE | Other services; Float revenue; Other fees; Other investment fees and expenses; Shareholder servicing fees; Custodial (securities) Service code 19 | — | $2K |
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 | 1,233 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 593 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,826 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 2,739 | $23.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 4,393 | $2.9M |
| Vision | VISION SERVICE PLAN | 1,349 | $146K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 153 | $263K |
| Other | U.S. BEHAVIORAL HEALTH PLAN OF CALIFORNIA DBA OPTUM | 1,671 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,393 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.