Form 5500 · Employee benefit plan · PASADENA, CA
BOARD OF TRUSTEES, SEIU LOCAL 721 EMPLOYEE BENEFITS
The filing calls this plan SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND.
BOARD OF TRUSTEES, SEIU LOCAL 721 EMPLOYEE BENEFITS of PASADENA, CA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Coverage is written through U.S. LEGAL SERVICES OF WISCONSIN, INC. and 10 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 26-3902233 · plan 501 · plan year 2025, filed Apr 15, 2026
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Life: the largest of the 3 insured life contracts, with TRUSTMARK LIFE INSURANCE COMPANY, covers 555 of 19,044 participants (2.9%) on Schedule A.
Disability: the largest of the 2 insured disability contracts, with RELIANCE STANDARD LIFE INSURANCE COMPANY, covers 226 of 19,044 participants (1.2%) on Schedule A.
Also declared: death benefits, 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 17 insured contracts covering health, dental, vision, life and disability.
Reported premium is $3,453,999; the filing discloses no broker commission on these contracts.
The health contract's policy period ended in June, while at least one ancillary line's policy period ended in September. 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.
11 carriers appear on the filing, including U.S. LEGAL SERVICES OF WISCONSIN, INC., BLUE SHIELD OF CALIFORNIA, VISION SERVICE PLAN and RELIANCE STANDARD LIFE INSURANCE COMPANY. U.S. LEGAL SERVICES OF WISCONSIN, INC. writes the largest contract by premium.
Schedule A insurance contracts
Premium and claims on these contracts
VISION SERVICE PLAN, contract 12242127. For the contract year on this filing, the carrier reported $511,532 in premium earned and $449,347 in claims incurred. Dividing one by the other gives 88%.
TRUSTMARK LIFE INSURANCE COMPANY, contract DY531. For the contract year on this filing, the carrier reported $263,200 in premium earned and $194,015 in claims incurred. Dividing one by the other gives 74%.
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC., contract 740324-000. For the contract year on this filing, the carrier reported $67,214 in premium earned and $26,647 in claims incurred. Dividing one by the other gives 40%.
- VISION SERVICE PLAN, contract 12242127 reported $79,288 in retention.
- TRUSTMARK LIFE INSURANCE COMPANY, contract DY531 reported $16,131 in retention.
- UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC., contract 740324-000 reported $47,635 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
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