| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LARRY KAY3 | 14135 RIVERSIDE DR #2 SHERMAN OAKS, CA 91423 | CALIFORNIA DENTAL NETWORK, INC. | $809 | — | $809 | 4.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Contract Administrator; Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 10 | — | $1.2M |
| PREMIER HEALTHCARE EXCHANGE, INC. EIN 86-1040704 NONE | Claims processing Service code 12 | — | $432K |
| UNITED HEALTHCARE INSURANCE COMPANY EIN 36-2739571 NONE | Claims processing Service code 12 | — | $129K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $96K |
| A.F. BUBENAS & CO. INC EIN 95-2368103 NONE | Consulting (general) Service code 16 | — | $60K |
| JOHN H. STEPHENS EIN 95-4124956 NONE | Legal Service code 29 | — | $39K |
| UNION BANK EIN 94-0304228 NONE | Custodial (other than securities) Service code 18 | — | $39K |
| PACIFIC INCOME ADVISORS EIN 95-4067974 NONE | Investment advisory (plan) Service code 27 | — | $33K |
| REICH ADELL & CVITAN EIN 95-3082677 NONE | Legal Service code 29 | — | $28K |
| WOHLNER KAPLON CUTLER HALFORD EIN 95-4177931 NONE | Legal Service code 29 | — | $18K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing Service code 12 | — | $17K |
| US BANK NATIONAL ASSOCIATION EIN 31-0841368 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $7K |
| DEMSEY, FILLIGER & ASSOCIATES EIN 14-1841288 NONE | Actuarial Service code 11 | — | $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 | 490 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 402 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 892 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLANS INC. | 898 | $8.0M |
| Dental(2 contracts, 2 carriers) | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | 396 | $75K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 480 | $19K |
| Prescription drug | UNITED AMERICAN INSURANCE COMPANY | 138 | $334K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 121 | $430K |
| Other(2 contracts, 2 carriers) | THE UNION LABOR LIFE INSURANCE COMPANY | 480 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 898 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.