| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | PREMERA BLUE CROSS | $34K | $5K | $39K | 4.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 603 NORTH 39TH AVENUE, SUITE 102 YAKIMA, WA 98902 | DELTA DENTAL OF WASHINGTON | $4K | — | $4K | 5.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2245 TEXAS DRIVE, SUITE 140 SUGAR LAND, TX 77479 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $649 | $6K | 17.50% |
| GREGORY J. HINE3 Filed as: GREGORY J HINE | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $452 | $0 | $452 | 10.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $216 | $13 | $229 | 5.35% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I BUCHOLTZ | 12517 217TH AVENUE COURT NE BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $135 | $0 | $135 | 3.15% |
| MICHAEL F FAHEY III3 | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $6 | $28 | 0.65% |
| TESSA LYNN CARPENTER3 | 8817 JAYDEN LANE NE LACEY, WA 98516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.47% |
| MJ INSURANCE3 Filed as: ROBERT D KIDD AND VARIOUS AGENTS | 707 SOUTH GRADY WAY RENTON, WA 98057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.28% |
| STEPHEN D BILLINGSLEY3 | 1143 EAST 300 SOUTH BOUNTIFUL, UT 84010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.23% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 114 | $846K |
| Dental | DELTA DENTAL OF WASHINGTON | 140 | $69K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $37K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $37K |
| Prescription drug | PREMERA BLUE CROSS | 114 | $846K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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.