| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PREMERA BLUE CROSS | $23K | $0 | $23K | 2.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 141 WEST JACKSON BOULEVARD SUITE 1000 CHICAGO, IL 60604 | PREMERA BLUE CROSS | $12K | $0 | $12K | 1.37% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1920 ATLANTA, GA 30339 | DELTA DENTAL OF WASHINGTON | $3K | $0 | $3K | 3.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 630 NORTH 39TH AVENUE, SUITE 102 YAKIMA, WA 98902 | DELTA DENTAL OF WASHINGTON | $1K | $0 | $1K | 1.71% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | $0 | $4K | 10.51% |
| 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 | $2K | $0 | $2K | 5.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $735 | $735 | 2.16% |
| GREGORY J. HINE3 Filed as: GREGORY HINE | 8118 62ND DRIVE NORTHEAST MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $211 | $0 | $211 | 5.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 777 108TH AVENUE NORTHEAST BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $172 | $6 | $178 | 4.46% |
| JUDY INEZ BUCHOLTZ3 | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $126 | $3 | $129 | 3.23% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $83 | $11 | $94 | 2.36% |
| MEGAN ELIZABETH CASTO3 | HOME OFFICE COLUMBIA, SC 29202 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $8 | $22 | 0.55% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $16 | $3 | $19 | 0.48% |
| STEPHEN D BILLINGSLEY3 Filed as: STEPHEN BILLINGSLEY & OTHER AGENTS | 1143 EAST 300 SOUTH BOUNTIFUL, UT 84010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.25% |
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 | 110 | $880K |
| Dental | DELTA DENTAL OF WASHINGTON | 133 | $77K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $34K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $34K |
| Prescription drug | PREMERA BLUE CROSS | 110 | $880K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.