| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES | PO BOX 845052 LOS ANGELES, CA 90084 | SUN LIFE ASSURANCE COMP OF CANADA | $14K | — | $14K | 3.68% |
| ON TARGET INSURANCE SERVICES LLC3 | PO BOX 2530 ROUND ROCK, TX 786802530 | SUN LIFE ASSURANCE COMP OF CANADA | $6K | — | $6K | 1.58% |
| JOSEPH MOCK3 Filed as: JOSEPH DOYLE MOCK | PO BOX 2530 ROUND ROCK, TX 78680 | SUN LIFE ASSURANCE COMP OF CANADA | $8K | — | $8K | 13.73% |
| JOSEPH MOCK3 | PO BOX 2530 ROUND ROCK, TX 78680 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 9.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMIN | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $78K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Direct payment from the plan; Other fees Service code 50 | — | $53K |
| ON TARGET INSURANCE SERVICES EIN 83-2963960 BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $48K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS OF CALIFORNIA | 182 | $35K |
| Life insurance | SUN LIFE ASSURANCE COMP OF CANADA | 280 | $56K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMP OF CANADA | 159 | $380K |
| Other | SUN LIFE ASSURANCE COMP OF CANADA | 280 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.