| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | 940 ADAMS STREET, SUITE G BENECIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $76K | — | $76K | 5.00% |
| AMWINS3 Filed as: AMWINS GROUP INC. | 4725 PIEDMONT ROW DR. SUITE 600 CHARLOTTE, NC 28210 | HCC LIFE INSURANCE COMPANY | $45K | — | $45K | 3.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | PO BOX 845052 LOS ANGELES, CA 90084 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | — | $13K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Other fees; Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $2.1M |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $197K |
| HS & BA EIN 94-3089465 NONE | Claims processing Service code 12 | — | $161K |
| WYNNE ALDANA EIN 94-6138741 EMPLOYEE | Employee (plan) Service code 30 | — | $69K |
| RAEL & LETSON EIN 94-1707048 NONE | Actuarial Service code 11 | — | $57K |
| WEINGBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal Service code 29 | — | $39K |
| VIVIAN MORI EIN 94-6138741 EMPLOYEE | Employee (plan) Service code 30 | — | $37K |
| ALEXIS BIRADELLI EIN 94-6138741 EMPLOYEE | Employee (plan) Service code 30 | — | $36K |
| SHELLY PEDERSON EIN 94-6138741 EMPLOYEE | Employee (plan) Service code 30 | — | $30K |
| SHEA LABAGH DOBBERSTEIN EIN 94-2290202 NONE | Accounting (including auditing) Service code 10 | — | $27K |
| BENESYS INC. NONE | Plan Administrator Service code 14 | 7180 KOLL CENTER PKWY PLEASANTON, CA 94566 | $20K |
| CIGNA HEALTH EIN 56-1971088 NONE | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $15K |
| SEGAL ROGERSCASEY NONE | Investment advisory (plan) Service code 27 | 333 WEST 34TH STREET SUITE 100 NEW YORK, NY 10001 | $10K |
| AMALGAMATED BANK EIN 13-4920330 NONE | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $1K |
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 | 922 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 230 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 26 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 885 | $1.5M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 698 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 885 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.