| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REGENCE GROUP ADMINISTRATORS5 | 220 120TH AVENUE BELLEVUE, WA 98005 | QBE INSURANCE | $0 | $13K | $13K | 4.05% |
| GARY LAPIDUS3 | PO BOX 547 WEIMAR, CA 95736 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 9.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCARE MANAGEMENT ADMINSTRATORS EIN 91-1333840 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 220 120TH AVENUE BELLEVUE, WA 98005 | $159K |
| GARY LAPIDUS INSURANCE BROKER | Contract Administrator Service code 13 | PO BOX 547 WEIMAR, CA 95736 | $45K |
| ENVISION PHARMACEUTICAL EIN 05-0570786 PHARMACY BENEFIT MANAGER | Contract Administrator Service code 13 | 2181 E. AUTORA ROAD TWINSBURG, OH 44087 | $13K |
| NAVIA BENEFITS SOLUTIONS, INC. EIN 91-1467758 FSA ADMINISTRATOR | Claims processing Service code 12 | 600 NACHES AVE. SW RENTON, WA 98057 | $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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 230 | $82K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 230 | $82K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 288 | $317K |
| Other | RELIANT BEHAVORIAL HEALTH | 452 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 452 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.