| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY Filed as: SEGAL COMPANY (WESTERN STATES) INC. | 1230 W. WASHINGTON ST. #501 TEMPE, AZ 85281 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $370 | $370 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS EIN 38-2383171 NONE | Plan Administrator Service code 14 | 7180 KOLL CENTER PARKWAY STE 200 PLEASANTON, CA 94566 | $512K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Accounting (including auditing); Insurance agents and brokers Service code 10 | 1230 WEST WASHINGTON STREET STE 5 TEMPE, AZ 85281 | $233K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Non-monetary compensation; Claims processing; Float revenue; Contract Administrator Service code 12 | 3900 E MEXICO AVE DENVER, CO 80210 | $227K |
| WISE/IMAGINE HEALTH EIN 26-4343123 NONE | Contract Administrator Service code 13 | 6995 UNION PARK CENTER STE 200 COTTONWOOD HEIGHTS, UT 84047 | $104K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 NONE | Plan Administrator; Claims processing Service code 12 | 100 FIRST STREET SAN FRANCISCO, CA 94105 | $86K |
| HEALTH EQUITY EIN 52-2383166 NONE | Contract Administrator; Insurance services Service code 13 | 15 W SCENIC POINTE DR STE 100 DRAPER, UT 840206120 | $77K |
| HORIZON BEHAVIORAL HEALTH EIN 59-3269144 NONE | Insurance services Service code 23 | PO BOX 840843 DALLAS, TX 75284 | $66K |
| EMPLOYERS RISK SERVICES EIN 20-8115302 NONE | Other services; Direct payment from the plan Service code 49 | 1240 FAIRWAY STREET PO BOX 628 BOWLING GREEN, KY 42102 | $64K |
| CAREOPERATIVE, LLC EIN 46-4399706 NONE | Other services Service code 49 | 5880 NOLENSVILLE PIKE, SUITE 200 NASHVILLE, TN 37211 | $46K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $45K |
| US BANK TRUST CO EIN 93-6157747 NONE | Custodial (securities) Service code 19 | 555 SOUTHWEST OAK ST PL 6 PORTLAND, OR 97204 | $42K |
| PANORAMIC PRESS INC NONE | Other services; Copying and duplicating Service code 36 | 2920 N 35TH ST PHOENIX, AZ 85018 | $40K |
| ROBERT W HANULA EIN 20-1437847 NONE | Legal Service code 29 | P.O. BOX 279 CARBONDALE, CO 81623 | $38K |
| GALLAGHER FIDUCIARY ADVISORS, LLC EIN 36-4291971 NONE | Investment advisory (plan) Service code 27 | TWO PIERCE PLACE ITASCA, IL 60143 | $26K |
| BALDWIN & BALDWIN PLLC EIN 46-4370753 NONE | Accounting (including auditing) Service code 10 | 701 NORTH 44TH STREET PHOENIX, AZ 85008 | $16K |
| NURTUR HEALTH INC EIN 06-1476380 NONE | Plan Administrator; Insurance services Service code 14 | 20 BATTERSON PARK ROAD FARMINGTON, CT 06032 | $9K |
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 | 1,976 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,976 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE COMPANY | 5,441 | $1.8M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,995 | $1.1M |
| Stop-loss / reinsurancereinsurance | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | 1,927 | $640K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,995 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,441 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.