| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R | — | HM LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS ADMINISTRATORS EIN 38-2383171 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $406K |
| OPTUM RX EIN 33-0441200 NONE | Direct payment from the plan; Other fees; Float revenue; Claims processing Service code 12 | — | $110K |
| US BANK EIN 31-0841368 NONE | Investment management; Custodial (securities); Direct payment from the plan Service code 19 | — | $83K |
| ANTHEM BLUE CROSS LIFE AND H.I. CO. EIN 95-4331852 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services Service code 12 | — | $73K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $58K |
| WOHLNER KAPLON CUTLER HALFORD ET AL EIN 83-2856417 NONE | Legal; Direct payment from the plan Service code 29 | — | $35K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $27K |
| MICHAEL SUROWITZ EIN 26-2336426 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| VSP EIN 94-1632821 NONE | Other services Service code 49 | — | $16K |
| FIRST DENTAL HEALTH EIN 33-0655193 NONE | Direct payment from the plan; Other services Service code 49 | — | $13K |
| MEDEXPERT INTERNATIONAL, INC. NONE | Consulting (general) Service code 16 | P.O. BOX 7550 MENLO PARK, CA 94026 | $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 | 906 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 54 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 960 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,316 | $10.3M |
| Dental(3 contracts, 3 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 843 | $3.7M |
| Vision | VISION SERVICE PLAN | 965 | $95K |
| Life insurance(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 878 | $176K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 1,316 | $6.8M |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 266 | $724K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 878 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,316 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.