| 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 | $31K | $6K | $37K | 4.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 603 NORTH 39TH AVENUE SUITE 102 YAKIMA, WA 98902 | DELTA DENTAL OF WASHINGTON | $4K | $0 | $4K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2245 TEXAS DRIVE SUITE 140 SUGAR LAND, TX 77479 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 16.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2345 GRAND BOULEVARD SUITE 400 KANSAS CITY, MO 64108 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $636 | $636 | 1.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $216 | $5 | $221 | 7.00% |
| GREGORY J. HINE3 | 8118 62ND DRIVE NORTHEAST MARYSVILLE, WA 98270 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $142 | $0 | $142 | 4.50% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $76 | $4 | $80 | 2.53% |
| HR BENEFITS SERVICES, INC.3 Filed as: NW BENEFITS GROUP, LLC | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $3 | $15 | 0.48% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY LII | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $1 | $12 | 0.38% |
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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 107 | $784K |
| Dental | DELTA DENTAL OF WASHINGTON | 139 | $77K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 107 | $33K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 107 | $33K |
| Prescription drug | PREMERA BLUE CROSS | 107 | $784K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 107 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.