| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $711 | $711 | 3.22% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $26 | $26 | 0.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH SERVICE & BENEFIT ADMIN EIN 94-3089465 NONE | Participant communication; Accounting (including auditing); Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Claims processing; Direct payment from the plan Service code 10 | — | $167K |
| U.A. LOCAL 159 EIN 94-0944925 SPONSORING LOCAL | Plan Administrator; Direct payment from the plan Service code 14 | — | $99K |
| KRAW LAW GROUP, APC EIN 32-0465891 NONE | Legal; Direct payment from the plan Service code 29 | — | $80K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | — | $77K |
| WITHUMSMITH+BROWN, PC EIN 22-2027092 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $77K |
| WEX HEALTH, INC. EIN 06-1593514 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other fees Service code 15 | — | $26K |
| ALAN BILLER & ASSOCIATES EIN 94-2854958 NONE | Consulting (pension); Investment advisory (plan); Direct payment from the plan Service code 17 | — | $9K |
| BANK OF AMERICA EIN 94-1687655 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $9K |
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 | 187 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 119 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 306 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 551 | $5.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 513 | $402K |
| Vision | VISION SERVICE PLAN | 287 | $33K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 316 | $22K |
| Prescription drug(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 94 | $1.4M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 191 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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.