| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENECIA, CA 94510 | UNION LABOR LIFE INSURANCE COMPANY | $56K | — | $56K | 9.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS EIN 95-4331852 UNAFFILIATED | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $10.2M |
| OPTUMRX, INC EIN 33-0441200 UNAFFILIATED | Direct payment from the plan; Claims processing; Float revenue; Other fees Service code 12 | PO BOX 9472 MINNEAPOLIS, MN 55440 | $3.3M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 UNAFFILIATED | Plan Administrator; Claims processing; Contract Administrator Service code 12 | 2323 EASTLAKE AVE E. SEATTLE, WA 98102 | $1.6M |
| RAEL & LETSON EIN 94-1701048 UNAFFILIATED | Consulting (general); Actuarial Service code 11 | 378 VINTAGE PARK DRIVE FOSTER CITY, CA 94404 | $124K |
| TEAMSTERS LOCAL 856 EIN 94-1211646 UNION ASSOC.W/PLAN | Contract Administrator Service code 13 | 453 SAN MATEO AVENUE SAN BRUNO, CA 94066 | $120K |
| REUBEN E PRICE & CO. (PAYROLL EXAM) EIN 94-3089756 UNAFFILIATED | Accounting (including auditing) Service code 10 | 3011 CITRUS CIRCLE, SUITE 207 WALNUT CREEK, CA 94598 | $94K |
| NEW ENGLAND PENSION CONSULTANTS EIN 26-1428909 UNAFFILIATED | Consulting (pension); Direct payment from the plan Service code 17 | 9440 WEST SAHARA AVE., SUITE 225 LAS VEGAS, NV 89117 | $75K |
| ASCENDANT HEALTHCARE EIN 26-3768186 UNAFFILIATED | Consulting (general) Service code 16 | 1755 INDIAN WOOD CIRCLE, SUITE 100 MAUMEE, OK 43537 | $74K |
| REUBEN E. PRICE & CO.(AUDIT/COMPL.) EIN 94-3089756 UNAFFILIATED | Accounting (including auditing) Service code 10 | 3011 CITRUS CIRCLE, SUITE 207 WALNUT CREEK, CA 94598 | $64K |
| CHARLES SCULLY, JR. EIN 94-2690827 UNAFFILIATED | Legal Service code 29 | 300 MONTGOMERY STREET, SUITE 735 SAN FRANCISCO, CA 94104 | $59K |
| WELLS FARGO EIN 94-1347393 UNAFFILIATED | Other services Service code 49 | PO BOX 63020 SAN FRANCISCO, CA 94163 | $35K |
| MARSH USA EIN 36-1436000 UNAFFILIATED | Insurance agents and brokers; Insurance services Service code 22 | 9171 TOWNE CENTRE DR. SAN DIEGO, CA 92122 | $26K |
| THE VIRTUOUS GROUP EIN 27-0365275 UNAFFILIATED | Consulting fees Service code 70 | 1930 VILLAGE CENTER CIRCLE, 3-397 LAS VEGAS, NV 89134 | $26K |
| FIRST DENTAL HEALTH EIN 33-0655193 UNAFFILIATED | Other services Service code 49 | PO BOX 919029 SAN DIEGO, CA 92191 | $25K |
| JULIE WALL (PH)650-580-7021 TRUSTEE | Trustee (individual) Service code 20 | 7660 BODEGA AVE SEBASTOPOL, CA 95472 | $22K |
| ULLICO INVESTMENT EIN 13-1423090 UNAFFILIATED | Investment management fees paid indirectly by plan Service code 52 | 8403 COLESVILLE RD SILVER SPRING, MO 20910 | $22K |
| PACIFIC ASSET MANAGEMENT EIN 95-1079000 UNAFFILIATED | Investment management fees paid indirectly by plan Service code 52 | 840 NEWKPORT CENTER DR., 7TH FLOOR NEWPORT BEACH, CA 92660 | $20K |
| DOUGLAS CORNFORD (PH) 415-515-1914 TRUSTEE | Trustee (individual) Service code 20 | PO BOX 32212 GENOA, NV 89411 | $16K |
| IRON MOUNTAIN STORAGE EIN 04-3038590 UNAFFILIATED | Recordkeeping fees Service code 64 | 745 ATLANTIC AVE. BOSTON, MA 02111 | $13K |
| BRUCE CONHAIM (PH)707-864-8649 TRUSTEE | Trustee (individual) Service code 20 | 103 TARTAN WAY FAIRFIELD, CA 94535 | $9K |
| SERVICE PRINTING EIN 91-0830372 UNAFFILIATED | Copying and duplicating Service code 36 | 3837 13TH AVE W., SUITE 106 SEATTLE, WA 98119 | $8K |
| UNITED STATES POSTAL SERVICE EIN 41-0760000 UNAFFILIATED | Other services Service code 49 | 475 LENFANT PLAZA SW WASHINGTON, DC 20260 | $6K |
| SUBURBAN PRESS EIN 94-2477030 UNAFFILIATED | Copying and duplicating Service code 36 | 22426 THUNDERBIRD PLACE HAYWARD, CA 94546 | $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 | 4,839 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,027 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,866 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER PERMANENTE | 4,548 | $68.6M |
| Dental(2 contracts, 2 carriers) | DELTA CARE PMI | 415 | $283K |
| Vision | VISION SERVICE PLAN | 1,931 | $260K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,303 | $24K |
| Prescription drug | UNITED AMERICAN INSURANCE COMPANY | 631 | $931K |
| Stop-loss / reinsurancereinsurance | UNION LABOR LIFE INSURANCE COMPANY | 1,010 | $567K |
| Other(5 contracts, 5 carriers) | KAISER PERMANENTE | 6,493 | $59.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,493 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.