| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PREMERA BLUE CROSS | $33K | $4K | $37K | 3.50% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | UNKNOWN KIRKLAND, WA 98033 | DELTA DENTAL OF WASHINGTON | $4K | $0 | $4K | 5.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $356 | $6K | 16.58% |
| GREGORY J. HINE3 Filed as: GREGORY HINE | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $552 | $0 | $552 | 8.17% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $324 | $17 | $341 | 5.05% |
| JUDY INEZ BUCHOLTZ3 | 12517 -217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $267 | $10 | $277 | 4.10% |
| MEGAN ELIZABETH CASTO3 | UNKNOWN COLUMBIA, SC 29202 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $49 | $26 | $75 | 1.11% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.18% |
| BRIAN WHITE3 Filed as: BRIAN RODERICK | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.06% |
| STEPHEN D BILLINGSLEY3 Filed as: STEPHEN D. BILLINGSLEY | 1143 EAST 300 SOUTH BOUNTIFUL, UT 84010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 192 | $1.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 131 | $83K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 101 | $35K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 101 | $35K |
| Prescription drug | PREMERA BLUE CROSS | 192 | $1.1M |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 25 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.