| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $66 | $66 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHRIM BENEFITS GROUP EIN 20-2534702 BROKER | Insurance agents and brokers Service code 22 | — | $75K |
| EMPLOYEE BENEFIT MGMT SERVICES, INC EIN 81-0391256 TPA | Contract Administrator Service code 13 | — | $69K |
| AETNA SIGNATURE ADMINISTRATORS EIN 06-6033492 PPO | Other services Service code 49 | — | $25K |
| COMPSYCH CORPORATION EIN 36-3739783 EAP | Other services Service code 49 | — | $8K |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $177K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $177K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $177K |
| Prescription drug | HCC LIFE INSURANCE COMPANY | 401 | $503K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 401 | $503K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 401 | — |
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.