| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $86K | — | $86K | 5.00% |
| AMWINS3 Filed as: AMWINS GROUP, INC. | 4725 PIEDMONT ROW DRIVE, SUITE 600 CHARLOTTE, NC 28210 | HCC LIFE INSURANCE COMPANY | $51K | — | $51K | 3.00% |
| STOP LOSS INSURANCE SERVICES, INC. | 940 ADAMS STREET, SUITE G BENICIA, CA 94105 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | — | $16K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MMGT | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $2.8M |
| BENESYS INC. NONE | Plan Administrator Service code 14 | 7180 KOLL CENTER PKWY PLEASANTON, CA 94566 | $241K |
| RAEL & LETSON EIN 94-1707048 NONE | Consulting (general); Actuarial Service code 11 | — | $67K |
| 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 | — | $43K |
| SHEA LABAGH DOBBERSTEIN EIN 94-2290202 NONE | Accounting (including auditing) Service code 10 | — | $31K |
| WEINBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal Service code 29 | — | $29K |
| CIGNA HEALTH EIN 56-1971088 NONE | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $16K |
| SEGAL ROGERSCASEY NONE | Investment advisory (plan) Service code 27 | 10880 WILSHIRE BLVD SUITE 850 LOS ANGELES, CA 90024 | $10K |
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 | 1,073 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 207 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 27 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 1,030 | $1.7M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,030 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,030 | — |
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.