| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: BUCKINGHAM STOP LOSS | 1250 BETHLEHEM PIKE, SUITE S212 HATFIELD, PA 19440 | STANDARD LIFE & ACCIDENT INSURANCE COMPANY | $20K | — | $20K | 4.89% |
| LIBERTY BENEFITS GROUP LLC3 | 20715 95TH AVE SE. SNOHOMISH, WA 98296 | CONTINENTAL AMERICAN INSURANCE COMPANY | $24K | — | $24K | 8.18% |
| DAVID ROJAS3 | 169 EAGLE RIDGE DRIVE E PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INSURANCE COMPANY | $106 | — | $106 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LBG ADVISORS, LLC EIN 92-0193132 NONE | Insurance services; Direct payment from the plan; Consulting fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $173K |
| THE LOOMIS COMPANY NONE | Other services; Accounting (including auditing); Recordkeeping fees; Participant communication; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Plan Administrator; Claims processing Service code 10 | P.O. BOX 7011 WYOMISSING, PA 196106011 | $88K |
| NICK LAZZARETTO TRUST MANAGER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Consulting fees; Direct payment from the plan; Participant communication; Plan Administrator; Contract Administrator Service code 13 | 30502 NE. 182ND AVE YACOLT, WA 98675 | $67K |
| FORVIS MAZARS, LLP EIN 44-0160260 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $31K |
| PAYER MATRIX NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Copying and duplicating; Recordkeeping fees; Participant communication; Plan Administrator; Other services; Accounting (including auditing); Contract Administrator; Claims processing Service code 10 | 1400 N. PROVIDENCE RD. BLDG 2. MEDIA, PA 19063 | $21K |
| 6 DEGREES NONE | Copying and duplicating; Direct payment from the plan; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing); Other services; Claims processing; Plan Administrator; Contract Administrator; Recordkeeping fees Service code 10 | 1600 NW. COMPTON DR, STE 208 BEAVERTON, OR 97006 | $21K |
| FIRST CHOICE HEALTH NETWORK, INC. EIN 91-1272766 NONE | Other services; Accounting (including auditing); Recordkeeping fees; Participant communication; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Plan Administrator; Claims processing Service code 10 | — | $20K |
| SMB ACCOUNTING SERVICES, LLC NONE | Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 10 | 4562 SW. 11TH STREET GRESHAM, OR 97080 | $14K |
| MEDWATCH LLC NONE | Recordkeeping fees; Participant communication; Contract Administrator; Copying and duplicating; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing; Accounting (including auditing); Plan Administrator Service code 10 | 400 COLONIAL CENTER PKWY, STE. 230 LAKE MARY, FL 32746 | $13K |
| BARLOW & COUGHRAN, P.S. NONE | Legal; Direct payment from the plan Service code 29 | 1325 FOURTH AVENUE, SUITE 910 SEATTLE, WA 98101 | $12K |
| HINES & ASSOCIATES, INC. NONE | Accounting (including auditing); Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication; Copying and duplicating; Recordkeeping fees; Contract Administrator; Claims processing; Direct payment from the plan; Plan Administrator Service code 10 | 115 E HIGHLAND AVE ELGIN, IL 60120 | $8K |
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 | 225 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CONTINENTAL AMERICAN INSURANCE COMPANY | 232 | $290K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 683 | $365K |
| Long-term disability | STANDARD INSURANCE COMPANY | 185 | $150K |
| Stop-loss / reinsurancereinsurance | STANDARD LIFE & ACCIDENT INSURANCE COMPANY | 0 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 683 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.