| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | 18700 N HAYDEN ROAD STE 405 SCOTTSDALE, AZ 85255 | COMPANION LIFE INSURANCE COMPANY | $40K | — | $40K | 6.00% |
| AMWINS3 | 4725 PIEDMONT ROW DRIVE STE 600 CHARLOTTE, NC 28210 | 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 | — | $511K |
| VALENZ CLAIM | Direct payment from the plan; Consulting fees; Consulting (general) Service code 16 | DEPT 3819 PO BOX 123819 DALLAS, TX 75312 | $209K |
| BRADLEY L. MIDDLETON, PC EIN 93-1215960 | Legal; Direct payment from the plan Service code 29 | — | $102K |
| MIDDLETON & CO, CPA, PC EIN 93-0809066 | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $78K |
| 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 |
| LABOR FIRST, LLC EIN 06-1750191 | Direct payment from the plan; Consulting (general) Service code 16 | 1000 MIDLANTIC DRIVE STE 100 MOUNT LAUREL, NJ 08054 | $40K |
| MILLIMAN EIN 91-0675641 | Direct payment from the plan; Consulting fees; Actuarial Service code 11 | 1455 SW BROADWAY STE 1600 PORTLAND, OR 97201 | $18K |
| MODA HEALTH, INC. EIN 93-0989307 | Direct payment from the plan; Claims processing Service code 12 | 601 SW SECOND AVENUE PORTLAND, OR 97204 | $12K |
| KEYCORP EIN 34-6542451 | Custodial (securities); Shareholder servicing fees; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Direct payment from the plan; Custodial (other than securities); Contract Administrator; Account maintenance fees Service code 13 | — | $11K |
| KEYCORP 34-6542451 | Recordkeeping fees; Account maintenance fees; Contract Administrator; Custodial (other than securities); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Direct payment from the plan; Custodial (securities); Shareholder servicing fees Service code 13 | — | $213 |
| DODGE & COX FUNDS - DODIX EIN 94-3073289 | Other investment fees and expenses; Distribution (12b-1) fees; Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| DODGE & COX FUNDS - DODIX 94-307328 | Other investment fees and expenses; Insurance brokerage commissions and fees; Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| METROPOLITAN WEST ASSET MGMT, LLC EIN 95-4625304 | Distribution (12b-1) fees; Other investment fees and expenses; Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| METROPOLITAN WEST ASSET MGMT, LLC 9 | 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 | 504 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 110 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 614 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 104 | $494K |
| Dental(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 104 | $532K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 526 | $543K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 508 | $11K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 104 | $494K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 470 | $660K |
| Other(3 contracts, 3 carriers) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 508 | $296K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 526 | — |
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."
No prospect flags tripped on this filing.