| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | PREMERA BLUE CROSS | $26K | $4K | $30K | 4.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 603 NORTH 39TH AVENUE, SUITE 102 YAKIMA, WA 98902 | DELTA DENTAL OF WASHINGTON | $3K | — | $3K | 4.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 12.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2245 TEXAS DRIVE, SUITE 140 SUGAR LAND, TX 77479 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 5.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $474 | $474 | 2.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SUN LIFE ASSURANCE COMPANY OF CANADA | $859 | — | $859 | 10.78% |
| GREGORY J. HINE3 | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $438 | — | $438 | 13.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $267 | $9 | $276 | 8.32% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517-217TH AVENUE COURT E BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $69 | $1 | $70 | 2.11% |
| RONNA BURGER3 | 3521 EAST N STREET TACOMA, WA 98404 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $51 | $70 | 2.11% |
| BRIAN WHITE3 Filed as: BRIAN RODERICK | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $17 | $45 | 1.36% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $8 | $19 | 0.57% |
| RANDY DAHL3 | 707 SOUTH GRADY WAY RENTON, WA 98404 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.06% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 61 | $650K |
| Dental | DELTA DENTAL OF WASHINGTON | 124 | $65K |
| Life insurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $31K |
| Long-term disability(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $31K |
| Prescription drug | PREMERA BLUE CROSS | 61 | $650K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 127 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.