| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERREMEDY INSURANCE SERVICES3 | 315 MONTGOMERY ST STE 900 SAN FRANCISCO, CA 94111 | HCC LIFE INSURANCE COMPANY | $13K | — | $13K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Copying and duplicating; Claims processing; Direct payment from the plan; Investment management fees paid directly by plan; Contract Administrator; Investment management Service code 12 | — | $376K |
| PREMERA BLUE CROSS EIN 91-0499247 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $150K |
| PROPEL INSURANCE EIN 90-0830024 NONE | Direct payment from the plan; Insurance agents and brokers; Insurance services; Insurance brokerage commissions and fees Service code 22 | — | $44K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 NONE | Direct payment from the plan; Other services Service code 49 | — | $23K |
| DAVID L. TUTTLE, ATTORNEY AT LAW NONE | Legal; Direct payment from the plan Service code 29 | 33530 1ST WAY S STE 102 FEDERAL WAY, WA 98003 | $18K |
| WELLS FARGO EIN 94-1347393 NONE | Direct payment from the plan; Other services; Custodial (securities) Service code 19 | — | $18K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $15K |
| LINDQUIST LLP NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 5000 EXECUTIVE PKWY STE 400 SAN RAMON, CA 94583 | $13K |
| MCKENZIE ROTHWELL BARLOW & COUGHRAN EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $13K |
| MILLIMAN, INC. EIN 91-0675641 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $8K |
| HEALTHCARE COST MANAGEMENT CORP NONE | Direct payment from the plan; Other services Service code 49 | 3000 A ST STE 300 ANCHORAGE, AK 99503 | $8K |
| TRUSTEE 01 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 2323 EASTLAKE AVE E SEATTLE, WA 98102 | $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 | 730 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 161 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 891 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AETNA LIFE INSURANCE CO. | 1,268 | $6K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 736 | $262K |
| Other | AETNA LIFE INSURANCE CO. | 1,268 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,268 | — |
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.