| 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 STE. G BENICIA, CA 94510 | ANTHEM BLUE CROSS | $78K | — | $78K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HS & BA EIN 94-3089465 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $247K |
| BLUE CROSS EIN 95-3760980 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $126K |
| SEYFARTH SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $61K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $58K |
| MCMORGAN & CO. NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 1 FRONT STREET, SUITE 500 SAN FRANCISCO, CA 94111 | $41K |
| HORIZON ACTUARIAL SERVICES EIN 38-3647875 NONE | Direct payment from the plan Service code 50 | — | $35K |
| VAVRINEK, TRINE, DAY & CO., LLP EIN 95-2648289 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $32K |
| TEAMSTERS ASSISTANCE PROGRAM EIN 94-2825071 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $22K |
| BEESON, TAYER EIN 94-2148509 NONE | Legal; Direct payment from the plan Service code 29 | — | $22K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $16K |
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 | 972 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 972 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 545 | $331K |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS | 597 | $782K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,158 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.