Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingBroker comp is under 1% of premium on a plan over $1M. The plan may have no broker or pay a flat fee. Consultants can pitch it.
The top carrier holds over 85% of premium. A rate increase from that carrier moves the whole plan.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
HealthHMO | HealthHMO | |
HealthHMO | HealthHMO | |
Dental | Dental | |
LifeOther | LifeOther | |
Broker: Rael & Letson Vision | Vision |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 5 contracts with Pro. Pro is free for 7 days and then costs $49 a month.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 223 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 223 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 0 | $4.1M |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA | 0 | $56K |
| Vision | VISION SERVICE PLAN | 0 | $6K |
| Life insurance | THE HARTFORD | 0 | $7K |
| Other | THE HARTFORD | 0 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | - |
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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
| Broker | Commissions |
|---|---|
Carrier: Vision Service Plan |
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFIC SOUTHWEST ADMINISTRATORS EIN 46-4942970 NONE | Contract Administrator Service code 13 | 1055 PARK VIEW DRIVE SUITE 111 COVINA, CA 91724 | $95K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial Service code 11 | 35 NORTH LAKE AVENUE SUITE 900 PASADENA, CA 91101 | $50K |
| HANEY & SHAH LLP EIN 26-4391858 NONE | Legal Service code 29 | 1055 WEST 7TH STREET SUITE 1950 LOS ANGELES, CA 90017 | $43K |
| DAVID BRODY & CO EIN 95-4778275 NONE | Accounting (including auditing) Service code 10 | 17785 CENTER COURT DRIVE SUITE 680 CERRITOS, CA 90703 | $23K |
| CITIZENS BUSINESS BANK EIN 95-6806148 NONE | Investment management Service code 28 | 701 N HAVEN AVENUE ONTARIO, CA 91764 | $19K |
| EIDE BAILLY LLP EIN 95-6975448 NONE | Accounting (including auditing) Service code 10 | 4040 CAMPBELL AVE STE 200 MENLO PARK, CA 94025 | $11K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
1 contact
11 filings · 2015 to 2025