| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST STE G BENICIA, CA 945102950 | HCC LIFE INSURANCE COMPANY | $22K | — | $22K | 7.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 NONE | Claims processing; Float revenue; Other fees; Direct payment from the plan Service code 12 | — | $1.3M |
| BENESYS, INC. EIN 38-2383171 NONE | Plan Administrator Service code 14 | — | $818K |
| BAYSPORT INC NONE | Other services Service code 49 | 14830 LOS GATOS BLVD STE 101 LOS GATOS, CA 95032 | $198K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general) Service code 16 | — | $66K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $60K |
| WEDGE CAPITAL MANAGEMENT EIN 56-1557450 NONE | Investment management fees paid directly by plan Service code 51 | — | $56K |
| CHARTWELL INVESTMENT PARTNERS, LLC EIN 36-4776242 NONE | Named fiduciary; Investment management; Investment management fees paid directly by plan Service code 28 | — | $49K |
| LEONARD CARDER, LLP EIN 94-2819269 NONE | Legal Service code 29 | — | $37K |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | — | $31K |
| MORNEAU SHEPELL, LTD EIN 52-1883918 NONE | Other services Service code 49 | — | $21K |
| SAN JOAQUIN & CALAVERAS CTY JATC EIN 94-6411032 NONE | Other services Service code 49 | — | $21K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Consulting (general); Investment advisory (plan) Service code 16 | — | $13K |
| JOHN H MILLER FSA CONSULTING ACTRY NONE | Actuarial Service code 11 | PO BOX 428 MILL VALLEY, CA 94942 | $10K |
| COMERICA EIN 42-1741646 NONE | Custodial (securities) Service code 19 | — | $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 | 1,498 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 559 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,057 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 3,444 | $31.5M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 4,909 | $3.4M |
| Vision | VISION SERVICE PLAN | 1,543 | $169K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 124 | $308K |
| Other | U.S. BEHAVIORAL HEALTH PLAN OF CALIFORNIA DBA OPTUM | 1,864 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,909 | — |
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.