| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD L SMITH | 36584 EMERALD COVE PALM DESSERT, CA 92211 | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | $2K | — | $2K | 1.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 NONE | Contract Administrator Service code 13 | — | $251K |
| BLUE CROSS EIN 95-4331852 NONE | Other services; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $125K |
| SEYFARTH SHAW EIN 36-2152202 NONE | Legal Service code 29 | — | $82K |
| HORIZON ACTUARIAL SERVICES EIN 38-3647875 NONE | Actuarial; Consulting (general) Service code 11 | — | $47K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Actuarial Service code 11 | — | $47K |
| REICH, ADELL, CVITAN EIN 95-3082677 NONE | Legal; Direct payment from the plan Service code 29 | — | $33K |
| HENNINGFIELD & ASSOCIATES, INC. EIN 54-2189926 NONE | Accounting (including auditing) Service code 10 | — | $24K |
| PACIFIC INCOME ADVISORS EIN 95-4067974 NONE | Investment management fees paid indirectly by plan Service code 52 | — | $15K |
| BERTRAM HENICK, DDS EIN 54-8446026 NONE | Consulting (general) Service code 16 | — | $11K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Contract Administrator Service code 13 | — | $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 | 1,011 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 212 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS, INC. | 1,267 | $5.4M |
| Dental(2 contracts, 2 carriers) | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | 681 | $90K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 676 | $646K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,267 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.