| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERREMDY INSURANCE SERVICES3 | 315 MONTGOMERY ST STE 900 SAN FRANCISCO, CA 94104 | HCC LIFE INSURANCE COMPANY | $20K | — | $20K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 NONE | Contract Administrator; Direct payment from the plan; Investment management; Investment management fees paid directly by plan; Claims processing Service code 12 | — | $449K |
| PREMERA BLUE CROSS EIN 91-0499247 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $214K |
| BARLOW COUGHRAN MORALES & JOSEPHSON EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $90K |
| PROPEL INSURANCE EIN 90-0830024 NONE | Insurance agents and brokers; Insurance services; Insurance brokerage commissions and fees; Direct payment from the plan Service code 22 | — | $45K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 NONE | Direct payment from the plan; Other services; Insurance services Service code 23 | — | $39K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 NONE | Other services; Direct payment from the plan Service code 49 | — | $18K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $17K |
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 | 931 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 146 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,077 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA INSURANCE COMPANY OF NEW YORK | 170 | $733K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 749 | $10K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 993 | $398K |
| Other | HARTFORD LIFE AND ACCIDENT | 749 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 993 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.