| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAMBRIAN CONSULTING, INC. Filed as: CAMBRIAN CONSULTING | 16770 NE 79TH STREET SUITE 207 REDMOND, WA 98052 | HCC LIFE INSURANCE COMPANY | — | $858 | $858 | 0.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRUSTEED PLANS SERVICE CORPORATION EIN 91-0780588 NONE | Contract Administrator Service code 13 | PO BOX 1894 TACOMA, WA 98401 | $133K |
| FIRST CHOICE HEALTH EIN 91-1272766 NONE | Other services Service code 49 | MS 310170 PO BOX 94041 SEATTLE, WA 98124 | $31K |
| AMERICAN HEATLH HOLDING EIN 31-1367946 NONE | Other services Service code 49 | 100 W OLD WILSON BRIDGE RD THIRD FLOOR PO BOX 6016 WORTHINGTON, OH 43085 | $11K |
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 | 532 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 534 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 554 | $35K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 593 | $53K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 541 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 593 | — |
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.