| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET, SUITE G BENICIA, CA 945102950 | HCC LIFE INSURANCE COMPANY | $19K | — | $19K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PROGRAMS ADMINISTRATION EIN 13-2501278 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $392K |
| RAEL & LETSON EIN 94-1701048 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $92K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing) Service code 10 | — | $28K |
| DECARLO AND SHANLEY EIN 95-4022565 NONE | Legal Service code 29 | — | $23K |
| FIRST HEALTH EIN 20-1736437 NONE | Insurance services Service code 23 | — | $21K |
| UNION BANK OF CALIFORNIA EIN 94-0304228 NONE | Custodial (securities); Custodial (other than securities) Service code 18 | — | $15K |
| SEGAL ADVISORS EIN 13-2646110 NONE | Investment advisory (plan) Service code 27 | — | $10K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing Service code 12 | — | $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 | 1,579 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,581 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 655 | $3.1M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 330 | $54K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 655 | $3.1M |
| Life insurance | UNIMERICA LIFE INSURANCE SERVICES | 447 | $11K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 655 | $3.1M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 153 | $387K |
| Other | UNIMERICA LIFE INSURANCE SERVICES | 447 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 655 | — |
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.