| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON | P. O. BOX 740722 LOS ANGELES, CA 90074 | HEALTH NET | $22K | — | $22K | 1.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNION ROOFERS ADMIN. EIN 95-2159333 PLAN ADMINISTRATOR | Plan Administrator; Contract Administrator Service code 13 | 9901 PARAMOUNT BLVD., SUITE 211 DOWNEY, CA 90240 | $411K |
| MCMORGAN & COMPANY EIN 94-1650768 NONE | Investment management Service code 28 | 425 MARKET STREET, SUITE 1600 SAN FRANCISCO, CA 94105 | $32K |
| DECARLO & SHANLEY EIN 95-4022565 NONE | Legal Service code 29 | 533 S. FREMONT AVE., 9TH FLOOR LOS ANGELES, CA 90071 | $22K |
| CYNTHIA GRAYDON EIN 56-2455975 NONE | Consulting (general) Service code 16 | 30 SILVER FOREST COURT AZUSA, CA 91702 | $21K |
| UNION BANK OF CAL. EIN 94-1234979 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | 445 S. FIGUEROA LOS ANGELES, CA 90071 | $13K |
| US BANK EIN 31-0841368 NONE | Custodial (securities) Service code 19 | 221 FIGUEROA, SUITE 210 LOS ANGELES, CA 90012 | $12K |
| BERNARD KOTKIN CO LLP EIN 95-2556670 NONE | Accounting (including auditing) Service code 10 | 533 S. FREMONT AVE., SUITE 802 LOS ANGELES, CA 90071 | $11K |
| MICHAEL SUROWITZ EIN 20-5535752 NONE | Accounting (including auditing) Service code 10 | 28026 DRYWELL CIR. CASTAIC, CA 91384 | $9K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial Service code 11 | 378 VINTAGE PARK DRIVE FOSTER CITY, CA 94404 | $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 | 777 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 812 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 1,848 | $8.1M |
| Dental | DELTA DENTAL OF CALIFORNIA | 604 | $192K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 608 | $1.6M |
| Life insurance | HCC LIFE INSURANCE COMPANY | 894 | $220K |
| Other | STANDARD INSURANCE COMPANY | 871 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,848 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.