| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON4 Filed as: RAEL AND LETSON | 378 VINTAGE PARK DRIVE FOSTER CITY, CA 94404 | BLUE SHIELD OF CALIFORNIA | — | $609 | $609 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORCORAN ADMINISTRATORS NONE | Direct payment from the plan; Copying and duplicating; Contract Administrator Service code 13 | 3313 VINCENT RD STE 216 PLEASANT HILL, CA 94523 | $345K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan; Actuarial Service code 11 | — | $145K |
| CIGNA EIN 59-1031071 NONE | Other services; Participant communication; Direct payment from the plan; Float revenue; Contract Administrator; Claims processing; Non-monetary compensation Service code 12 | — | $132K |
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Contract Administrator; Copying and duplicating; Direct payment from the plan Service code 13 | — | $121K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $102K |
| GILBERT & SACKMAN EIN 95-2906951 NONE | Legal Service code 29 | — | $33K |
| UNION BANK EIN 94-0304288 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $26K |
| US BANK NONE | Custodial (securities) Service code 19 | 80 S 8TH ST STE 224 MINNEAPOLIS, MN 55402 | $18K |
| THE SEGAL COMPANY NONE | Other fees Service code 99 | 333 W 34TH ST NEW YORK, NY 10001 | $13K |
| MICHAEL SURROWITZ COMPLIANCE VERIF. EIN 26-2336426 NONE | Accounting (including auditing) Service code 10 | — | $9K |
| IRON MOUNTAIN EIN 04-3038590 NONE | Other services Service code 49 | — | $7K |
| RICHARD SANCHEZ TRUSTEE | Trustee (individual) Service code 20 | 1325 N GRAND AVE STE 200 COVINA, CA 91724 | $5K |
| JACK MORCK TRUSTEE | Trustee (individual) Service code 20 | 620 RIVER DRIVE NORCO, CA 92860 | $5K |
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 | 1,039 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 437 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,476 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 2,142 | $14.3M |
| Dental(3 contracts, 2 carriers) | CIGNA DENTAL HEALTH OF CA, INC. | 1,750 | $264K |
| Vision(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 1,171 | $4.9M |
| Life insurance | AETNA LIFE INSURANCE CO. | 1,808 | $155K |
| Short-term disability | AETNA LIFE INSURANCE CO. | 1,808 | $155K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 1,171 | $4.7M |
| Stop-loss / reinsurancereinsurance(2 contracts) | HCC LIFE INSURANCE COMPANY | 178 | $348K |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 1,808 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,142 | — |
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.