| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN INC. | — | — | $0 | 0.00% |
| NONE | — | UNITEDHEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENECIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $32K | — | $32K | 5.26% |
| NONE | — | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| NONE | — | THE UNION LABOR LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS ADMINISTRATORS EIN 38-2383171 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $218K |
| RAEL & LETSON EIN 94-1701042 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $89K |
| BLUE SHIELD EIN 94-0360524 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $71K |
| KRAW LAW GROUP EIN 77-0171216 NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $60K |
| VAVRINEK, TRINE, DAY & CO., LLP EIN 95-2648289 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $31K |
| PENN CAPITAL EIN 45-0635462 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $18K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $15K |
| HEALTHNOW NONE | Direct payment from the plan; Claims processing Service code 12 | 801 LAKEVIEW DRIVE, SUITE 301 BLUE BELL, PA 14922 | $14K |
| INVESTMENT PERFORMANCE SERVICES LLC EIN 58-2432390 NONE | Investment advisory (plan); Investment management fees paid indirectly by plan; Direct payment from the plan Service code 27 | — | $10K |
| JACOBS & CO. EIN 94-3056301 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $9K |
| RICHARD ROMANSKI EIN 94-6173454 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $9K |
| W.W. WARD III EIN 94-6173454 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $9K |
| MCCRAKEN, STEMERMAN, & HOLSBERRY EIN 94-1770955 NONE | Legal; Direct payment from the plan Service code 29 | — | $7K |
| COMERICA BANK EIN 38-3243681 NONE | Float revenue; Other investment fees and expenses; Direct payment from the plan; Shareholder servicing fees; Other services; Custodial (securities) Service code 19 | — | $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 | 756 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 46 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 802 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 77 | $966K |
| Vision | VISION SERVICE PLAN | 766 | $109K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 672 | $13K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 369 | $599K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 672 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,114 | — |
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.