| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R.L. EVANS COMPANY, INC.3 Filed as: RL EVANS COMPANY INC | STERLING PLZ STE 120 3535 FACTORIA BLVD SE BELLEVUE, WA 98006 | STANDARD INSURANCE COMPANY | $35K | — | $35K | 3.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SEATTLE POLICE OFFICERS GUILD EIN 91-0603202 RELATED PARTY | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator Service code 14 | — | $83K |
| POLICE OFFICERS RELIEF ASSOC. OF CA NONE | Legal Service code 29 | PO BOX 693130 STOCKTON, CA 95269 | $48K |
| SAICHEK LAW FIRM, APC EIN 26-0802656 NONE | Legal Service code 29 | — | $32K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $15K |
| ROGER DIXON NONE | Other services Service code 49 | 580 KAIOLA ST KIHEI, HI 96753 | $14K |
| KAUHALE MAKAI NONE | Other services Service code 49 | 938 S KIHEI RD KIHEI, HI 96753 | $14K |
| IN THE BLACK, LLC EIN 26-3874052 NONE | Accounting (including auditing) Service code 10 | — | $7K |
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 | 1,320 | 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) | 1,320 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Long-term disability | STANDARD INSURANCE COMPANY | 1,320 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,320 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.