| 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 | $130K | — | $130K | 9.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS EIN 95-4331852 UNAFFILIATED | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Claims processing Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $18.8M |
| OPTUMRX, INC EIN 33-0441200 UNAFFILIATED | Direct payment from the plan; Other fees; Float revenue; Claims processing Service code 12 | PO BOX 9472 MINNEAPOLIS, MN 55440 | $4.9M |
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 UNAFFILIATED | Claims processing; Contract Administrator; Plan Administrator Service code 12 | 2323 EASTLAKE AVE E. SEATTLE, WA 98102 | $1.8M |
| TEAMSTERS LOCAL 856 EIN 94-1211646 UNION ASSOC.W/PLAN | Contract Administrator Service code 13 | 453 SAN MATEO AVENUE SAN BRUNO, CA 94066 | $120K |
| RAEL & LETSON EIN 94-1701048 UNAFFILIATED | Consulting (general); Actuarial Service code 11 | 378 VINTAGE PARK DRIVE FOSTER CITY, CA 94404 | $101K |
| 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 |
| ASCENDANT HEALTHCARE EIN 26-3768186 UNAFFILIATED | Consulting (general) Service code 16 | 1755 INDIAN WOOD CIRCLE, SUITE 100 MAUMEE, OK 43537 | $84K |
| 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 | $76K |
| CHARLES SCULLY, JR. EIN 94-2690827 UNAFFILIATED | Legal Service code 29 | 300 MONTGOMERY STREET, SUITE 735 SAN FRANCISCO, CA 94104 | $66K |
| 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 |
| WELLS FARGO EIN 94-1347393 UNAFFILIATED | Other services Service code 49 | PO BOX 63020 SAN FRANCISCO, CA 94163 | $34K |
| MARSH USA EIN 36-1436000 UNAFFILIATED | Insurance services; Insurance agents and brokers Service code 22 | 9171 TOWNE CENTRE DR. SAN DIEGO, CA 92122 | $25K |
| FIRST DENTAL HEALTH EIN 33-0655193 UNAFFILIATED | Other services Service code 49 | PO BOX 919029 SAN DIEGO, CA 92191 | $25K |
| ULLICO INVESTMENT EIN 13-1423090 UNAFFILIATED | Investment management fees paid indirectly by plan Service code 52 | 8403 COLESVILLE RD SILVER SPRING, MO 20910 | $22K |
| JULIE WALL (PH)650-580-7021 TRUSTEE | Trustee (individual) Service code 20 | 7660 BODEGA AVE SEBASTOPOL, CA 95472 | $22K |
| DOUGLAS CORNFORD (PH) 415-515-1914 TRUSTEE | Trustee (individual) Service code 20 | PO BOX 32212 GENOA, NV 89411 | $21K |
| BRUCE CONHAIM (PH)707-864-8649 TRUSTEE | Trustee (individual) Service code 20 | 103 TARTAN WAY FAIRFIELD, CA 94535 | $21K |
| 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 | $21K |
| THE VIRTUOUS GROUP EIN 27-0365275 UNAFFILIATED | Consulting (general) Service code 16 | 1930 VILLAGE CENTER CIRCLE, 3-397 LAS VEGAS, NV 89134 | $20K |
| ZELIS CLAIMS INTEGRITY LLC EIN 86-1040704 UNAFFILIATED | Other services Service code 49 | PO BOX 412162 BOSTON, MA 022412162 | $18K |
| SERVICE PRINTING EIN 91-0830372 UNAFFILIATED | Copying and duplicating Service code 36 | 3837 13TH AVE W., SUITE 106 SEATTLE, WA 98119 | $16K |
| IRON MOUNTAIN STORAGE EIN 04-3038590 UNAFFILIATED | Recordkeeping fees Service code 64 | 745 ATLANTIC AVE. BOSTON, MA 02111 | $16K |
| SUBURBAN PRESS EIN 94-2477030 UNAFFILIATED | Other services; Copying and duplicating Service code 36 | 22426 THUNDERBIRD PLACE HAYWARD, CA 94545 | $14K |
| UNITED STATES POSTAL SERVICE EIN 41-0760000 UNAFFILIATED | Other services Service code 49 | 475 LENFANT PLAZA SW WASHINGTON, DC 20260 | $7K |
| INTERNATIONAL FOUNDATION OF EBP EIN 39-1034021 UNAFFILIATED | Other services Service code 49 | 18700 WEST BLUEMOUND RD. BROOKFIELD, WI 53045 | $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 | 4,764 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,232 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,996 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER PERMANENTE | 4,530 | $68.9M |
| Dental(2 contracts, 2 carriers) | DELTA CARE PMI | 308 | $280K |
| Vision | VISION SERVICE PLAN | 1,657 | $240K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,129 | $23K |
| Prescription drug | UNITED AMERICAN INSURANCE COMPANY | 635 | $1.3M |
| Stop-loss / reinsurancereinsurance | UNION LABOR LIFE INSURANCE COMPANY | 1,369 | $1.3M |
| Other(5 contracts, 5 carriers) | KAISER PERMANENTE | 6,535 | $70.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,535 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.