| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| NONE | — | WESTPORT INSURANCE CORPORATION | — | — | $0 | 0.00% |
| NONE | — | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| BROKERAGE CONCEPTS INC5 Filed as: BROKERAGE CONCEPTS, INC | 801 LAKEVIEW DRIVE, SUITE 301 BLUE BELL, PA 19422 | HEALTHNOW ADMINISTRATIVE SERVICES | — | $323 | $323 | 0.34% |
| NONE | — | CLAREMONT BEHAVIORAL SERVICES | — | — | $0 | 0.00% |
| NONE | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS ADMINISTRATORS EIN 38-2383171 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $274K |
| RAEL & LETSON EIN 94-1457076 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $73K |
| KRAW LAW GROUP EIN 77-0171216 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $67K |
| BLUE SHIELD NONE | Direct payment from the plan; Actuarial Service code 11 | 601 12TH STREET OAKLAND, CA 94607 | $55K |
| HEALTHNOW EIN 11-3667763 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $40K |
| LOOMIS SAYLES EIN 94-1554520 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $24K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $23K |
| KAUFMANN & GOBLE NONE | Direct payment from the plan Service code 50 | 160 W. SANTA CLARA ST., SUITE 1550 SAN JOSE, CA 95113 | $22K |
| VAVRINEK, TRINE, DAY & CO. LLP EIN 95-2648289 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $18K |
| ALAN BILLER & ASSOCIATES EIN 94-2854958 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $17K |
| US BANK EIN 31-0841368 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $14K |
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 | 568 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 62 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 630 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 471 | $96K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 521 | $13K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | WESTPORT INSURANCE CORPORATION | 568 | $388K |
| Other | CLAREMONT BEHAVIORAL SERVICES | 514 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 603 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.