| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERREMEDY INSURANCE SERVICES3 | 315 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | HCC LIFE INSURANCE COMPANY | — | $12K | $12K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 36-1236610 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $112K |
| ASSOCIATED THIRD PARTY ADMINISTRATO NONE | Contract Administrator Service code 13 | 1211 W. 22ND STREET, 406 OAK BROOK, IL 60532 | $45K |
| PROPEL INSURANCE EIN 91-0830024 NONE | Consulting fees; Insurance agents and brokers; Consulting (general) Service code 16 | — | $28K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $22K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| AMALGAMATED BANK EIN 36-0721895 NONE | Direct payment from the plan; Investment management Service code 28 | — | $8K |
| GLOBALCARE NONE | Other services Service code 49 | 6875 SHILOH ROAD EAST ALPHARETTA, GA 300058372 | $6K |
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 | 113 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 141 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 240 | $270K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 314 | $243K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 240 | $270K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.