| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON | 378 VINTAGE PARK DR FOSTER CITY, CA 94404 | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| 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 | $92K |
| HANEY & SHAH LLP EIN 26-4391858 NONE | Legal Service code 29 | 1055 WEST 7TH STREET SUITE 1950 LOS ANGELES, CA 90017 | $53K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial Service code 11 | 35 NORTH LAKE AVENUE SUITE 900 PASADENA, CA 91101 | $47K |
| EIDE BAILLY LLP EIN 95-6975448 NONE | Accounting (including auditing) Service code 10 | 4040 CAMPBELL AVE STE 200 MENLO PARK, CA 94025 | $33K |
| CITIZENS BUSINESS BANK EIN 95-6806148 NONE | Investment management Service code 28 | 701 N HAVEN AVENUE ONTARIO, CA 91764 | $18K |
| DAVID BRODY & CO EIN 95-4778275 NONE | Accounting (including auditing) Service code 10 | 17785 CENTER COURT DRIVE SUITE 680 CERRITOS, CA 90703 | $17K |
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 | 325 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 0 | $4.3M |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA | 0 | $75K |
| Vision | VISION SERVICE PLAN | 0 | $5K |
| Life insurance | THE HARTFORD | 0 | $4K |
| Other | THE HARTFORD | 0 | $4K |
| 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 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.