| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $63K | — | $63K | 10.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MASONRY INDUSTRY TRUST ADMIN. EIN 93-1144705 | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Direct payment from the plan; Contract Administrator Service code 12 | — | $377K |
| VALENZ CLAIM | Consulting (general); Direct payment from the plan; Consulting fees Service code 16 | DEPT 3819 PO BOX 123819 DALLAS, TX 75312 | $224K |
| BRADLEY L. MIDDLETON, PC EIN 93-1215960 | Legal; Direct payment from the plan Service code 29 | — | $158K |
| MIDDLETON & CO, CPA, PC EIN 93-0809066 | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $66K |
| INNOVATIVE CARE MANAGEMENT | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | PO BOX 22386 PORTLAND, OR 97269 | $54K |
| KEYCORP EIN 34-6542451 | Recordkeeping fees; Account maintenance fees; Direct payment from the plan; Custodial (other than securities); Contract Administrator; Custodial (securities); Shareholder servicing fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $13K |
| PROSERVE HEALTH INFORMATICS | Direct payment from the plan; Consulting (general) Service code 16 | PO BOX 968 CUYAHOGA FALLS, OH 44223 | $13K |
| MODA HEALTH, INC. EIN 93-0989307 | Direct payment from the plan; Claims processing Service code 12 | 601 SW SECOND AVENUE PORTLAND, OR 97204 | $11K |
| METROPOLITAN WEST ASSET MGMT, LLC 9 | Investment management fees paid indirectly by plan; Other investment fees and expenses; Distribution (12b-1) fees Service code 52 | — | $10K |
| DODGE & COX FUNDS - DODIX 94-307328 | Investment management fees paid indirectly by plan; Insurance brokerage commissions and fees; Other investment fees and expenses Service code 52 | — | $7K |
| ECHO HEALTH, INC. | Copying and duplicating; Consulting (general); Direct payment from the plan Service code 16 | 868 CORPORATE WAY WESTLAKE, OH 44145 | $7K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 | Direct payment from the plan; Other insurance fees and expenses; Insurance services Service code 23 | — | $5K |
| KEYCORP 34-6542451 | Account maintenance fees; Shareholder servicing fees; Direct payment from the plan; Custodial (other than securities); Recordkeeping fees; Contract Administrator; Custodial (securities); Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $187 |
| DODGE & COX FUNDS - DODIX EIN 94-3073289 | Investment management fees paid indirectly by plan; Other investment fees and expenses; Distribution (12b-1) fees Service code 52 | — | $0 |
| METROPOLITAN WEST ASSET MGMT, LLC EIN 95-4625304 | Investment management fees paid indirectly by plan; Distribution (12b-1) fees; Other investment fees and expenses Service code 52 | — | $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 | 697 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 135 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 832 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 127 | $469K |
| Dental(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 127 | $507K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 572 | $526K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 700 | $14K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 139 | $761K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 654 | $629K |
| Other(3 contracts, 3 carriers) | UNITED AMERICAN INSURANCE COMPANY | 700 | $291K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 700 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.