| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC. Filed as: STOP LOSS INSURANCE SERVICES | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | NATIONAL UNION FIRE INSURANCE COMPANY OF PA | $35K | — | $35K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPUSYS OF UTAH, INC. EIN 85-0203669 | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $460K |
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Non-monetary compensation; Claims processing; Named fiduciary; Float revenue Service code 12 | — | $420K |
| SONG MONDRESS PLLC | Legal Service code 29 | 720 THIRD AVE STE 1500 SEATTLE, WA 98104 | $101K |
| RAEL LETSON | Actuarial Service code 11 | 378 VINTAGE PARK DRIVE FROST CITY, CA 94404 | $98K |
| ENVISION PHARMACEUTICAL SERVICES | Claims processing Service code 12 | 2181 EAST AURORA RD 201 TWINSBURG, OH 44087 | $66K |
| SAGAMORE HEALTH NETWORK EIN 59-1031071 | Claims processing Service code 12 | PO BOX 6051 INDIANAPOLIS, IN 46206 | $49K |
| HAYNIE & COMPANY | Accounting (including auditing) Service code 10 | 1785 WEST 2300 SOUTH SALT LAKE CITY, UT 84119 | $38K |
| AUDIT SERVICES, INC. EIN 84-0411241 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing) Service code 10 | PO BOX 68 SUN RIVER, MT 59483 | $16K |
| WASHINGTON CAPITAL MANAGEMENT, INC. | Investment management Service code 28 | 1301 FIFTH AVE STE 3100 SEATTLE, WA 981012632 | $13K |
| KENNETH B. GRIMES, P.C. | Legal Service code 29 | 142 E 200 S STE 312 SALT LAKE CITY, UT 84111 | $10K |
| U.S BANK EIN 98-0826646 | Custodial (other than securities) Service code 18 | 555 SOUTHWEST OAK PORTLAND, OR 97204 | $10K |
| DEBOER & ASSOCIATES | Accounting (including auditing) Service code 10 | 17330 WRIGHT ST STE 100 OMAHA, NE 681302157 | $9K |
| NEEDLES & ASSOCIATES, LLC | Accounting (including auditing) Service code 10 | 350 INTERLOCKEN BLVD S220 BROOMFIELD, CO 80021 | $7K |
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 | 1,417 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 127 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,544 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITEDHEALTH CARE INSURANCE COMPANY | 1,406 | $43K |
| Stop-loss / reinsurancereinsurance | NATIONAL UNION FIRE INSURANCE COMPANY OF PA | 1,532 | $701K |
| Other(2 contracts) | UNITEDHEALTH CARE INSURANCE COMPANY | 1,406 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,532 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.