| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIBERTY BENEFITS GROUP LLC3 | 20715 95TH AVE SE SNOHOMISH, WA 98296 | CONTINENTAL AMERICAN INS. COMPANY | $25K | — | $25K | 7.91% |
| DAVID ROJAS3 | 169 EAGLE RIDGE DR E PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INS. COMPANY | $154 | — | $154 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LBG ADVISORS, LLC EIN 92-0193132 NONE | Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Consulting fees; Direct payment from the plan Service code 15 | — | $110K |
| 6 DEGREES NONE | Plan Administrator; Contract Administrator; Other services; Recordkeeping fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication; Copying and duplicating; Direct payment from the plan; Accounting (including auditing) Service code 10 | 1600 NW COMPTON DR, STE 208 BEAVERTON, OR 97006 | $89K |
| THE LOOMIS COMPANY NONE | Contract Administrator; Plan Administrator; Participant communication; Claims processing; Copying and duplicating; Recordkeeping fees; Accounting (including auditing); Other services; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 10 | PO BOX 7011 WYOMISSING, PA 196106011 | $72K |
| HINES & ASSOCIATES, INC. NONE | Recordkeeping fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing); Copying and duplicating; Direct payment from the plan; Plan Administrator; Participant communication; Other services; Contract Administrator Service code 10 | 115 E HIGHLAND AVE ELGIN, IL 60120 | $55K |
| SCHOEDEL & SCHOEDEL CPA PLLC EIN 91-0614823 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $36K |
| PAYER MATRIX LLC NONE | Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Recordkeeping fees; Accounting (including auditing); Contract Administrator; Direct payment from the plan; Other services; Participant communication; Claims processing Service code 10 | 1400 N PROVIDENCE RD, BL 2, SU 5000 MEDIA, PA 19063 | $33K |
| MYWORKPLACE, INC. NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other services; Copying and duplicating; Accounting (including auditing); Recordkeeping fees Service code 10 | 400 N LOOP 1604 E, SUITE 110 SAN ANTONIO, TX 78232 | $26K |
| HEALTHJOY, LLC NONE | Direct payment from the plan; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing); Other services Service code 10 | PO BOX 776932 CHICAGO, IL 606776932 | $21K |
| FIRST CHOICE HEALTH NETWORK, INC. EIN 91-1272766 NONE | Participant communication; Plan Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Accounting (including auditing); Recordkeeping fees; Copying and duplicating; Claims processing; Other services Service code 10 | — | $20K |
| CAREOPERATIVE LLC NONE | Recordkeeping fees; Accounting (including auditing); Direct payment from the plan; Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other services; Participant communication; Contract Administrator; Copying and duplicating Service code 10 | 340 SEVEN SPRINGS WAY, STE 600 BRENTWOOD, TN 37027 | $8K |
| MEDWATCH LLC NONE | Other services; Consulting fees; Direct payment from the plan Service code 49 | 400 COLONIAL CENTER PKWY, STE 230 LAKE MARY, FL 32746 | $6K |
| BARLOW COUGHRAN MORALES & JOSEPHSON EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $6K |
| HEALTHCARE BLUE BOOK NONE | Direct payment from the plan; Other services; Consulting fees Service code 49 | 340 SEVEN SPRINGS WAY, STE 600 BRENTWOOD, TN 37027 | $5K |
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 | 227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CONTINENTAL AMERICAN INS. COMPANY | 240 | $312K |
| Dental | METROPOLITAN LIFE INS. COMPANY | 705 | $371K |
| Long-term disability | STANDARD INSURANCE COMPANY | 196 | $140K |
| Stop-loss / reinsurancereinsurance | GARDEN STATE LIFE INSURANCE COMPANY | 271 | $362K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 705 | — |
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.