Form 5500 · Employee benefit plan · LOS ANGELES, CA
BOARD OF TRUSTEES, SANTA MONICA UNITE HERE HEALTH
The filing calls this plan SANTA MONICA UNITE HERE HEALTH BENEFIT PLAN.
BOARD OF TRUSTEES, SANTA MONICA UNITE HERE HEALTH of LOS ANGELES, CA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 5 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-6035138 · plan 501 · plan year 2024, filed Oct 11, 2025
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, dental and vision; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 14,908 people.
The filing declares health, dental, vision and life. Life appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium is $119,388,117; the filing discloses no broker commission on these contracts.
The health contract's policy period ended in May, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 14,908 | Jun 1, 2024 | $100,967,286 | $0 |
| HEALTH NET | Health | 1,489 | Jan 1, 2025 | $11,469,029 | $0 |
| DELTA DENTAL OF CALIFORNIA | Dental | 14,585 | Jan 1, 2025 | $5,641,672 | $0 |
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | Dental | 6,355 | Jan 1, 2025 | $882,384 | $0 |
| VISION SERVICE PLAN | Vision | 9,599 | Jan 1, 2025 | $340,780 | $0 |
| CARELON BEHAVIORAL HEALTH | — | 10,005 | Jan 1, 2025 | $86,966 | $0 |
Premium and claims on these contracts
DELTA DENTAL OF CALIFORNIA, contract 17975. For the contract year on this filing, the carrier reported $5,641,672 in premium earned and $4,476,729 in claims incurred. Dividing one by the other gives 79%.
LIBERTY DENTAL PLAN OF CALIFORNIA, INC., contract SMUHH. For the contract year on this filing, the carrier reported $882,384 in premium earned and $214,440 in claims incurred. Dividing one by the other gives 24%.
VISION SERVICE PLAN, contract 30092827. For the contract year on this filing, the carrier reported $340,780 in premium earned and $190,064 in claims incurred. Dividing one by the other gives 56%.
- DELTA DENTAL OF CALIFORNIA, contract 17975 reported $666,010 in retention.
- VISION SERVICE PLAN, contract 30092827 reported $47,711 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
Subscribers see how this compares with similar plans in California. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in California — largest plans, brokers, carriers and renewal months.