| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | BERKSHIRE HATHAWAY SPECIALITY INSURANCE CO. | $21K | — | $21K | 4.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | NATIONAL UNION FIRE INSURANCE CO. OF PA | $7K | — | $7K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MASONRY INDUSTRY TRUST ADMIN. EIN 93-1144705 | Direct payment from the plan; Contract Administrator; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $295K |
| MIDDLETON & CO., CPA, PC EIN 93-0809066 | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $74K |
| UNITED CLAIMS SOLUTION | Consulting (general); Consulting fees; Direct payment from the plan Service code 16 | 23048 N 15TH AVENUE PHOENIX, AZ 85027 | $67K |
| INNOVATIVE CARE MANAGEMENT | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | PO BOX 22386 PORTLAND, OR 97269 | $39K |
| OREGON DENTAL SERVICE EIN 93-0438772 | Claims processing; Direct payment from the plan Service code 12 | — | $34K |
| BRADLEY L. MIDDLETON, PC EIN 93-1215960 | Legal; Direct payment from the plan Service code 29 | — | $22K |
| QUEST INVESTMENT MANAGEMENT EIN 93-0880854 | Investment management fees paid directly by plan; Other investment fees and expenses; Direct payment from the plan; Investment management Service code 28 | — | $14K |
| ULLICO CASUALTY COMPANY EIN 13-2988846 | Direct payment from the plan; Insurance services; Other insurance fees and expenses Service code 23 | — | $7K |
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 | 486 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 92 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 578 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 1,195 | $133K |
| Vision | REGENCE BLUECROSS BLUESHIELD OF OREGON | 21 | $45K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 487 | $21K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 1,195 | $65K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKSHIRE HATHAWAY SPECIALITY INSURANCE CO. | 1,195 | $516K |
| Other(4 contracts, 4 carriers) | NATIONAL UNION FIRE INSURANCE CO. OF PA | 398 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,195 | — |
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.