| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTHCARE MANAGEMENT ADMINISTRATOR5 | 220 120TH AVENUE NE BELLEVUE, WA 98005 | HCC LIFE INSURANCE COMPANY | $6K | — | $6K | 2.14% |
| GARY LAPIDUS3 | PO BOX 547 WEIMAR, CA 95736 | LIFEMAP ASSURANCE COMPANY | $6K | — | $6K | 10.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCARE MANAGEMENT ADMINISTRATOR EIN 91-1333840 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 220 120TH AVENUE NE BELLEVUE, WA 98005 | $76K |
| ENVISION PHARMACEUTICAL SERVICES EIN 88-0511398 PHARMACY BENEFIT MANAGER | Insurance services Service code 23 | — | $8K |
| GARY LAPIDUS 36640 | Insurance agents and brokers Service code 22 | PO BOX 547 WEIMAR, CA 95736 | $0 |
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 | 153 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFEMAP ASSURANCE COMPANY | 158 | $54K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 158 | $54K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 158 | $54K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 158 | $274K |
| Other(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 158 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.