| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNION ROOFERS ADMINISTRATIVE EIN 95-2159333 PARTY-IN-INTEREST | Plan Administrator; Contract Administrator; Direct payment from the plan Service code 13 | — | $494K |
| REAL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $65K |
| MCMORGAN & COMPANY EIN 52-2334338 NONE | Direct payment from the plan; Investment management Service code 28 | — | $52K |
| CYNTHIA GRAYDON EIN 56-2455975 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $31K |
| US BANK EIN 31-0841368 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $17K |
| DECARLO SHANLEY APC EIN 95-4022565 NONE | Legal; Direct payment from the plan Service code 29 | — | $16K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $11K |
| MICHAEL SUROWITZ COMPLIANCE EIN 26-2336426 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $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 | 1,247 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,277 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 118 | $1.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 529 | $241K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 691 | $1.4M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE | 1,123 | $316K |
| Other | STANDARD INSURANCE COMPANY | 1,100 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,326 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.