| 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 | $32K | $6K | $39K | 4.79% |
| 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 | 16.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $669 | $669 | 2.00% |
| GREGORY J. HINE3 | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $146 | $0 | $146 | 5.38% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $82 | $20 | $102 | 3.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $0 | $70 | 2.58% |
| MARK CHARLES MORGAN3 | 2590 WILLAMETTE DRIVE NE LACEY, WA 98516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $27 | $34 | 1.25% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.37% |
| HR BENEFITS SERVICES, INC.3 Filed as: NW BENEFITS GROUP, LLC | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.18% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 143 | $810K |
| Dental | DELTA DENTAL OF WASHINGTON | 143 | $75K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $33K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $33K |
| Prescription drug | PREMERA BLUE CROSS | 143 | $810K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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.