| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALICE BOHNKER INSURANCE SERVICES3 | 709 37TH ST ANACORTES, WA 98221 | REGENCE BLUE SHIELD | — | $2K | $2K | 0.03% |
| AXIS INSURANCE LLC3 | 795 FRANKLIN AVE #206 FRANKLIN LANES, NJ 07417 | REGENCE BLUE SHIELD | — | $420 | $420 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WA INC SEATTLE | 1501 4TH AVENUE SUITE 2400 SEATTLE, WA 98101 | REGENCE BLUE SHIELD | — | $402 | $402 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WA TACOMA | 1145 BROADWAY #700 TACOMA, WA 98402 | REGENCE BLUE SHIELD | — | $138 | $138 | 0.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY #1950 ATLANTA, GA 30339 | REGENCE BLUE SHIELD | — | $132 | $132 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WA | 1501 4TH AVENUE SUITE 2400 SEATTLE, WA 98101 | REGENCE BLUE SHIELD | — | $42 | $42 | 0.00% |
| CONOVER INSURANCE SERVICES LLC3 | 3911 CASTLEVALE ROAD SUITE 201 YAKIMA, WA 98909 | ASURIS NORTHWEST HEALTH | — | $780 | $780 | 0.02% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY #1950 ATLANTA, GA 30339 | ASURIS NORTHWEST HEALTH | — | $282 | $282 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON | 1501 4TH AVENUE SUITE 2400 SEATTLE, WA 98101 | ASURIS NORTHWEST HEALTH | — | $186 | $186 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BROWN & BROWN OF WASHINGTON SEATTLE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 1501 4TH AVENUE #2400 SEATTLE, WA 98101 | $229K |
| WA FARM BUREAU SERVICE CO. EIN 91-1912012 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $192K |
| BENEFIT SOLUTIONS INC. EIN 91-1603312 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $175K |
| MCKENZIE ROTHWELL BARLOW & COUGHRAN NONE | Legal; Direct payment from the plan Service code 29 | 1325 4TH AVE SEATTLE, WA 98101 | $26K |
| ANASTASI MOORE & MARTIN PLLC EIN 20-8149084 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $12K |
| AMERICAN AGRICULTURAL INSURANCE NONE | Legal; Direct payment from the plan Service code 29 | 1501 WOODFIELD RD #300W SCHAUMBURG, IL 60173 | $10K |
| CARLA WILLARD TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 62002 N MCDONALD RD PROSSER, WA 99350 | $8K |
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 | 1,111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | REGENCE BLUE SHIELD | 1,506 | $11.8M |
| Dental | DELTA DENTAL OF WASHINGTON | 235 | $175K |
| Vision(2 contracts, 2 carriers) | VSP VISION CARE, INC. | 1,184 | $120K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 1,124 | $43K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUE SHIELD | 1,506 | $11.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,506 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.