| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LARRY KAY3 | 14135 RIVERSIDE DR #2 SHERMAN OAKS, CA 91423 | CALIFORNIA DENTAL NETWORK, INC. | $770 | — | $770 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Contract Administrator; Direct payment from the plan; Other fees; Accounting (including auditing); Claims processing Service code 10 | — | $1.5M |
| ZELIS CLAIMS INTEGRITY, LLC EIN 86-1040704 NONE | Other fees; Direct payment from the plan Service code 50 | — | $500K |
| REICH ADELL & CVITAN EIN 95-3082677 NONE | Legal; Direct payment from the plan Service code 29 | — | $67K |
| A.F. BUBENAS & CO. INC EIN 95-2368103 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $60K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $55K |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $49K |
| PACIFIC INCOME ADVISORS EIN 95-4067974 NONE | Direct payment from the plan; Investment management fees paid directly by plan Service code 50 | — | $46K |
| UNION BANK EIN 94-0304228 NONE | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $36K |
| JOHN H. STEPHENS EIN 95-4124956 NONE | Legal; Direct payment from the plan Service code 29 | — | $19K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $12K |
| SLEEP STRATEGIES NONE | Other fees; Direct payment from the plan Service code 50 | 5224 SUNRAY LANE LAS VEGAS, NV 89130 | $11K |
| US BANK NATIONAL ASSOCIATION EIN 31-0841368 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $10K |
| WOHLNER KAPLON CUTLER HALFORD & ROS EIN 95-4177931 NONE | Legal; Direct payment from the plan Service code 29 | — | $8K |
| PACIFIC CREST ACTUARIES, LLC EIN 81-4642259 NONE | Direct payment from the plan; 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 | 531 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 193 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 724 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 847 | $6.6M |
| Dental(2 contracts, 2 carriers) | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | 408 | $74K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 509 | $18K |
| Prescription drug | UNITED AMERICAN INSURANCE COMPANY | 73 | $174K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 169 | $992K |
| Other(2 contracts, 2 carriers) | THE UNION LABOR LIFE INSURANCE COMPANY | 509 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 847 | — |
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.