| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LARRY KAY3 | 14315 RIVERSIDE DR #2 SHERMAN OAKS, CA 91423 | CALIFORNIA DENTAL NETWORK, INC. | $1K | — | $1K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS, INC. EIN 52-1590516 NONE | Plan Administrator; Direct payment from the plan; Accounting (including auditing); Other fees; Claims processing; Contract Administrator Service code 10 | — | $1.3M |
| ANTHEM BLUE CROSS EIN 95-4331852 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $171K |
| PACIFIC INCOME ADVISORS EIN 95-4067974 NONE | Investment management fees paid directly by plan; Direct payment from the plan Service code 50 | — | $96K |
| A.F. BUBENAS & CO. INC EIN 95-2368103 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $74K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $67K |
| REICH ADELL & CVITAN EIN 95-3082677 NONE | Legal; Direct payment from the plan Service code 29 | — | $48K |
| MUFG UNION BANK, N.A. EIN 94-0304228 NONE | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $30K |
| WOHLNER KAPLON CUTLER HALFORD & ROS EIN 83-2856417 NONE | Legal; Direct payment from the plan Service code 29 | — | $25K |
| US BANK NATIONAL ASSOCIATION EIN 31-0841368 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $22K |
| MEDEXPERT INTERNATIONAL, INC. NONE | Other services; Direct payment from the plan Service code 49 | 1300 HANCOCK STREET REDWOOD CITY, CA 94063 | $10K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $10K |
| IRON MOUNTAIN NONE | Other services; Direct payment from the plan Service code 49 | 1201 N 96TH ST SEATTLE, WA 98103 | $7K |
| DODGE DATA AND ANALYTICS NONE | Other services; Direct payment from the plan Service code 49 | 300 AMERICAN METRO BLVD STE 185 HAMILTON, NJ 08619 | $7K |
| MILLIMAN, INC. EIN 91-0675641 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $7K |
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 | 579 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 103 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 682 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 784 | $9.3M |
| Dental(2 contracts, 2 carriers) | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | 362 | $92K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 0 | $0 |
| Prescription drug | UNITED AMERICAN INSURANCE COMPANY | 0 | $0 |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 0 | $0 |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 784 | — |
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.