| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | 18940 NORTH PIMA ROAD SUITE 210 SCOTTSDALE, AZ 85255 | BERKSHIRE HATHAWAY SPECIALITY INSURANCE CO. | $29K | — | $29K | 4.00% |
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | 18940 NORTH PIMA ROAD SUITE 210 SCOTTSDALE, AZ 85255 | HCC LIFE INSURANCE COMPANY | $8K | — | $8K | 9.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MASONRY INDUSTRY TRUST ADMIN. EIN 93-1144705 | Contract Administrator; Recordkeeping fees; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $314K |
| VALENZ CLAIM | Direct payment from the plan; Consulting fees; Consulting (general) Service code 16 | PO BOX 123819 DALLAS, TX 75312 | $167K |
| MIDDLETON & CO., CPA, PC EIN 93-0809066 | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $58K |
| 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 | $47K |
| QUEST INVESTMENT MANAGEMENT EIN 93-0880854 | Direct payment from the plan; Investment management fees paid directly by plan; Other investment fees and expenses; Investment management Service code 28 | — | $19K |
| MILLIMAN EIN 91-0675641 | Consulting fees; Actuarial; Direct payment from the plan Service code 11 | 1455 SW BROADWAY STE 1600 PORTLAND, OR 97201 | $19K |
| BRADLEY L. MIDDLETON, PC EIN 93-1215960 | Legal; Direct payment from the plan Service code 29 | — | $15K |
| 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; Direct payment from the plan; Other insurance fees and expenses Service code 23 | 333 WEST 34TH STREET NEW YORK, NY 100012402 | $8K |
| ECHO HEALTH INC. | Copying and duplicating; Direct payment from the plan; Consulting (general) Service code 16 | 868 CORPORATE WAY WESTLAKE, OH 44145 | $5K |
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 | 484 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 71 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 555 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 8 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 243 | $1.3M |
| Dental(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 1,129 | $1.7M |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 243 | $1.3M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 520 | $23K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 1,015 | $2.0M |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALITY INSURANCE CO. | 442 | $726K |
| Other(9 contracts, 8 carriers) | HCC LIFE INSURANCE COMPANY | 520 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,129 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.