| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES, INC | 940 ADAMS STREET, STUITE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $47K | — | $47K | 8.00% |
| NONE | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | RELIASTAR LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| NONE | — | MHN SERVICES | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| IRONWORKERS EMPLOYEES BENEFIT CORP EIN 95-3084599 NONE | Contract Administrator Service code 13 | — | $197K |
| BLUE CROSS EIN 95-4331852 NONE | Float revenue; Claims processing; Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $54K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial Service code 11 | — | $51K |
| SALTZMAN & JOHNSON EIN 94-2376174 NONE | Insurance agents and brokers Service code 22 | — | $30K |
| WELLDYN RX CLAIMS EIN 84-1515837 NONE | Contract Administrator Service code 13 | — | $18K |
| BERNARD KOTKIN & COPMANY, LLP EIN 95-2556670 NONE | Accounting (including auditing) Service code 10 | — | $16K |
| US BANK EIN 31-0841136 NONE | Investment advisory (participants) Service code 26 | — | $8K |
| ALAN D. BILLER & ASSOCIATES EIN 94-2854958 NONE | Trustee (individual) Service code 20 | — | $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 | 717 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 727 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 983 | $276K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 744 | $914K |
| Vision | VISION SERVICE PLAN | 847 | $83K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 994 | $51K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 928 | $589K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 994 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 994 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.