| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST, SUITE G BENICIA, CA 94510 | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | $8K | — | $8K | 2.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: EPIQ RISK MANAGEMENT | PO BOX 579258 MODESTO, CA 95357 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| CROWN RISK MANAGEMENT, LLC Filed as: EPIQ RISK MANAGEMENT | PO BOX 579258 MODESTO, CA 95357 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST., SUITE G BENICIA, CA 94105 | NATIONAL UNION FIRE INSURANCE COMPANY OF PA | $9K | — | $9K | 10.00% |
| BRIAN ULLRICH3 | PO BOX 579258 MODESTO, CA 95357 | VISION SERVICE PLAN | $2K | — | $2K | 3.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRISTAR BENEFIT ADMINISTRATORS EIN 38-3739503 NOT APPLICABLE | Claims processing Service code 12 | 12257 UNIVERSITY AVE 200 CLIVE, IA 50325 | $199K |
| S & S HEALTHCARE STRATEGIES, LTD EIN 31-1418743 NOT APPLICABLE | Other services Service code 49 | — | $91K |
| CONNECTION DENTAL EIN 43-1796335 NOT APPLICABLE | Other services Service code 49 | — | $6K |
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 | 636 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 636 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | 492 | $487K |
| Vision | VISION SERVICE PLAN | 554 | $51K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 856 | $383K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 856 | $221K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 856 | $221K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | 492 | $400K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 856 | — |
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."
No prospect flags tripped on this filing.