| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PREMERA BLUE CROSS | $50K | $5K | $55K | 4.41% |
| DIGITAL INSURANCE LLC3 | UNKNOWN KIRKLAND, WA 98033 | DELTA DENTAL OF WASHINGTON | $4K | $0 | $4K | 4.60% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $351 | $7K | 16.21% |
| GREGORY J. HINE3 Filed as: GREGORY HINE | 8118 62ND DRIVE NE, SUITE 100 MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $664 | $0 | $664 | 10.28% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $570 | $71 | $641 | 9.92% |
| JUDY INEZ BUCHOLTZ3 | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $217 | $14 | $231 | 3.57% |
| ROGERS BENEFIT GROUP INC3 Filed as: MICHELLE ANNISE ROGERS | 1065 BLAINE AVENUE NE, UNIT C RENTON, WA 98056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $56 | $78 | 1.21% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DRIVE SE OLYMPIA, WA 98501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $23 | $64 | 0.99% |
| MARY DAUGHERTY3 | PO BOX 119 ROCKY TOP, TN 37769 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $18 | $59 | 0.91% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III & OTHER AGENTS | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $6 | $24 | 0.37% |
No Schedule C service providers reported on this filing.
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 | 95 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 95 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 117 | $1.3M |
| Dental | DELTA DENTAL OF WASHINGTON | 114 | $77K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 95 | $40K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 95 | $40K |
| Prescription drug | PREMERA BLUE CROSS | 117 | $1.3M |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 24 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.