| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST STE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $18K | — | $18K | 7.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 NONE | Claims processing; Direct payment from the plan; Float revenue; Other fees Service code 12 | — | $1.6M |
| BENESYS, INC. EIN 38-2383171 NONE | Plan Administrator Service code 14 | — | $823K |
| ELECTRICAL INDUSTRY SERVICE CORP. EIN 94-3053367 RELATED ORGANIZATION | Plan Administrator Service code 14 | — | $145K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $56K |
| BENSINGER, DUPONT & ASSOCIATES EIN 36-3185080 NONE | Other services Service code 49 | — | $46K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $43K |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Claims processing; Other services Service code 12 | — | $30K |
| LEONARD CARDER, LLP EIN 94-2819269 NONE | Legal Service code 29 | — | $23K |
| SAN JOAQUIN & CALAVERAS CTY JATC EIN 94-6411032 NONE | Other services Service code 49 | — | $21K |
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 NONE | Investment advisory (plan) Service code 27 | — | $20K |
| DODGE & COX EIN 94-1441976 NONE | Investment management Service code 28 | — | $5K |
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 | 1,197 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 591 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,788 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 2,857 | $19.9M |
| Dental | DELTA DENTAL OF CALIFORNIA | 3,105 | $2.9M |
| Vision | VISION SERVICE PLAN | 1,373 | $152K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 143 | $260K |
| Other | U.S. BEHAVIORAL HEALTH PLAN OF CALIFORNIA DBA OPTUM | 0 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,105 | — |
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.