| 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. | $28K | — | $28K | 4.00% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | 940 ADAMS STREET SUITE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MASONRY INDUSTRY TRUST ADMIN. EIN 93-1144705 | Direct payment from the plan; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | — | $298K |
| VALENZ CLAIM | Direct payment from the plan; Consulting (general); Consulting fees Service code 16 | PO BOX 123819 DALLAS, TX 75312 | $69K |
| MIDDLETON & CO., CPA, PC EIN 93-0809066 | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $64K |
| BRADLEY L. MIDDLETON, PC EIN 93-1215960 | Legal; Direct payment from the plan Service code 29 | — | $39K |
| 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 | $38K |
| QUEST INVESTMENT MANAGEMENT EIN 93-0880854 | Investment management; Direct payment from the plan; Other investment fees and expenses; Investment management fees paid directly by plan Service code 28 | — | $18K |
| PROSERVE HEALTH INFORMATICS | Direct payment from the plan; Consulting (general) Service code 16 | PO BOX 968 CUYAHOGA FALLS, OH 44223 | $10K |
| SEGAL SELECT INSURANCE EIN 43-0619194 | Insurance services; Other insurance fees and expenses; Direct payment from the plan Service code 23 | 333 WEST 34TH STREET NEW YORK, NY 100012402 | $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 | 512 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 70 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 582 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 8 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 16 | $48K |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 1,165 | $337K |
| Vision | REGENCE BLUECROSS BLUESHIELD OF OREGON | 16 | $27K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 546 | $23K |
| Prescription drug(3 contracts, 3 carriers) | MODA HEALTH PLAN, INC. | 1,059 | $664K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKSHIRE HATHAWAY SPECIALITY INSURANCE CO. | 444 | $774K |
| Other(11 contracts, 10 carriers) | HCC LIFE INSURANCE COMPANY | 546 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,165 | — |
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.