| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERREMEDY INSURANCE SERVICES3 Filed as: INTERREMEDY INSURANCE SERVICES, LLC | 315 MONTGOMERY ST, SUITE 900 SAN FRANCISCO, CA 94104 | HCC LIFE INSURANCE COMPANY | $29K | — | $29K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WELFARE & PENSION ADMIN SERVICE INC EIN 91-1363171 NONE | Direct payment from the plan; Contract Administrator; Claims processing; Copying and duplicating Service code 12 | — | $421K |
| PREMERA BLUE CROSS BLUE SHIELD EIN 91-0499247 NONE | Direct payment from the plan; Claims processing; Other fees Service code 12 | — | $224K |
| PROPEL INSURANCE EIN 91-0830024 NONE | Insurance agents and brokers; Direct payment from the plan; Consulting (general) Service code 16 | — | $51K |
| KEYBANK NATIONAL ASSOCIATION EIN 92-0089306 NONE | Investment management; Custodial (securities); Direct payment from the plan; Shareholder servicing fees Service code 19 | — | $47K |
| MCKENZIE ROTHWELL BARLOW & COUGHRAN EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $44K |
| LINDQUIST LLP EIN 52-2385296 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $26K |
| QUALIS HEALTH EIN 91-1072875 NONE | Direct payment from the plan; Other services Service code 49 | — | $25K |
| LABOR TRUST SERVICES, INC. EIN 92-0134212 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $18K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing; Direct payment from the plan 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 | 860 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 65 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 98 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,023 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 956 | $19K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,045 | $584K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 956 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,045 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.