| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN | — | — | $0 | 0.00% |
| NONE | — | BLUE SHIELD OF CALIFORNIA | — | — | $0 | 0.00% |
| NONE | — | TOKIO MARINE HCC STOP LOSS GROUP | — | — | $0 | 0.00% |
| NONE | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | MANAGED HEALTH NETWORK | — | — | $0 | 0.00% |
| NONE | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | GERBER LIFE INSURANCE CO. | — | — | $0 | 0.00% |
| NONE | — | MANAGED HEALTH NETWORK | — | — | $0 | 0.00% |
| NONE | — | MHN SERVICES | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORCORAN ADMINISTRATORS NONE | Copying and duplicating; Direct payment from the plan; Contract Administrator Service code 13 | 3313 VINCENT ROAD, SUITE 216 PLEASANT HILL, CA 94523 | $467K |
| RAEL AND LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general); Actuarial Service code 11 | — | $266K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $56K |
| CIGNA NONE | Claims processing; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $44K |
| BLUE CROSS NONE | Direct payment from the plan; Claims processing Service code 12 | 225 NORTH MICHIGAN AVEN CHICAGO, IL 60601 | $40K |
| US BANK NONE | Direct payment from the plan; Custodial (securities) Service code 19 | 80 S 8TH STREET, SUITE 224 MINNEAPOLIS, MN 55402 | $39K |
| GILBERT & SACKMAN EIN 95-2906951 NONE | Legal; Direct payment from the plan Service code 29 | — | $34K |
| UNION BANK EIN 94-0304288 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $29K |
| MICHAEL SUROWITZ COMPLIANCE VERIFIC NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 23438 BALMORAL LANE WEST HILLS, CA 91307 | $26K |
| VISION SERVICE PLAN NONE | Claims processing; Direct payment from the plan Service code 12 | 3333 QUALITY DRIVE RANCHO CORDOVA, CA 95670 | $16K |
| EPLAN EIN 20-3720767 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $13K |
| LAURENCE BEAR EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $11K |
| JACK MORCK EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $11K |
| BILL BISTLINE EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $10K |
| LARRY OLINGER EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $9K |
| SALVADOR VASQUEZ EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $8K |
| MARTY GRECO EIN 95-2755074 TRUSTEE | Other fees; Trustee (individual) Service code 20 | — | $8K |
| CHRISTOPHER RAPP EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $8K |
| KEVIN KUCERA EIN 95-2755074 TRUSTEE | Trustee (individual); Other fees Service code 20 | — | $8K |
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 | 997 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 431 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,428 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN | 2,187 | $17.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,511 | $256K |
| Vision | GERBER LIFE INSURANCE CO. | 818 | $122K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $133K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 1,020 | $4.7M |
| Other(3 contracts, 3 carriers) | TOKIO MARINE HCC STOP LOSS GROUP | 612 | $474K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,187 | — |
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.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.