| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENICIA, CA 94510 | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | $75K | $34K | $109K | 14.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH SERVICES & BENEFIT ADMINISTR EIN 94-3089465 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $247K |
| SEYFARTH SHAW EIN 36-2152202 NONE | Legal; Direct payment from the plan Service code 29 | — | $150K |
| ANTHEM BLUE CROSS EIN 95-3760980 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $135K |
| MCMORGAN AND COMPANY EIN 52-2334338 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $92K |
| BEESON, TAYER & BODINE EIN 94-3126136 NONE | Legal; Direct payment from the plan Service code 29 | — | $70K |
| HORIZON ACTUARIAL SERVICES, LLC EIN 38-3647875 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $56K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $39K |
| HEALTHLINX LLC EIN 87-0660214 NONE | Direct payment from the plan; Other services Service code 49 | — | $28K |
| TEAMSTERS ASSISTANCE PROGRAM EIN 68-0048516 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $21K |
| EIDE BAILLY, LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $18K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $12K |
| OPTUMRX, INC. EIN 33-0441200 NONE | Float revenue; Claims processing; Other fees; Direct payment from the plan Service code 12 | — | $0 |
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 | 898 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 898 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 539 | $348K |
| Stop-loss / reinsurancereinsurance | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | 593 | $755K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,089 | — |
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.