| 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 | $15K | — | $15K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Direct payment from the plan; Investment management; Claims processing; Investment management fees paid directly by plan; Contract Administrator Service code 12 | — | $477K |
| PREMERA BLUE CROSS EIN 91-0499247 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $187K |
| MCKENZIE ROTHWELL BARLOW & COUGHRAN EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $67K |
| PROPEL INSURANCE EIN 90-0830024 NONE | Insurance services; Direct payment from the plan; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $45K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 NONE | Insurance services; Direct payment from the plan; Other services Service code 23 | — | $32K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 NONE | Direct payment from the plan; Other services Service code 49 | — | $18K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| HEALTHCARE ACTUARIES EIN 20-5718833 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $9K |
| BMI AUDIT SERVICES, LLC EIN 38-4091484 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $6K |
| STATE STREET BANK EIN 04-1867445 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $6K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $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 | 762 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 147 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 909 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 187 | $808K |
| Life insurance | AETNA LIFE INSURANCE CO. | 1,380 | $6K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 967 | $293K |
| Other | AETNA LIFE INSURANCE CO. | 1,380 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,380 | — |
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."
No prospect flags tripped on this filing.