| 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, SUITE G BENICIA, CA 945102950 | HCC LIFE INSURANCE COMPANY | $56K | — | $56K | 9.43% |
| NONE | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | MHN SERVICES LLC | — | — | $0 | 0.00% |
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | RELIASTAR LIFE INSURANCE COMPANY | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| IRONWORKERS EMPLOYEES BENEFIT CORP EIN 95-3084599 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $208K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan; Actuarial Service code 11 | — | $119K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $18K |
| SALTZMAN & JOHNSON EIN 94-2376174 NONE | Legal; Direct payment from the plan Service code 29 | — | $15K |
| WELLDYNE RX CLAIMS EIN 84-1515837 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $15K |
| BLUE CROSS EIN 95-4331852 NONE | Claims processing; Investment advisory (participants); Float revenue; Contract Administrator; Other services Service code 12 | — | $13K |
| VSP NONE | Contract Administrator Service code 13 | 3333 QUALITY DRIVE RANCHO CORDOVA, CA 95670 | $10K |
| US BANK EIN 31-0841368 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $9K |
| ALAN D. BILLER & ASSOCIATES EIN 94-2854958 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $7K |
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 | 549 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 556 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 109 | $264K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 646 | $855K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 0 | $0 |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 815 | $592K |
| Other(2 contracts, 2 carriers) | MHN SERVICES LLC | 768 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 815 | — |
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."
No prospect flags tripped on this filing.