| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 | 1325 4TH AVE. STE. 2100 SEATTLE, WA 98101 | PREMERA BLUE CROSS | $25K | $10K | $35K | 1.39% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF WASHINGTON, LLC | 1325 4TH AVE. ST. 2100 SEATTLE, WA 98101 | DELTA DENTAL OF WASHINGTON | $14K | — | $14K | 4.94% |
| TIMOTHY HELD3 | 11427 148TH AVE. NW GIG HARBOR, WA 98329 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9K | — | $9K | 4.86% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF WASHINGTON, LLC | 1325 4TH AVE. STE. 2100 SEATTLE, WA 98101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 2.92% |
| MARK G. LAWSON3 | 3145 VISTA PL. W. UNIVERSITY PLACE, WA 98466 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 1.08% |
| DAVID ROJAS3 | 169 EAGLE RIDGE DR. E. PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 0.66% |
| KYONG H. GOINS3 | 2931 1ST AVE. S. #A SEATTLE, WA 98134 | CONTINENTAL AMERICAN INSURANCE COMPANY | $792 | — | $792 | 0.43% |
| CLACK ATTACK AGENCY, LLC3 | 949 MARKET ST. STE. 241 TACOMA, WA 98402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $770 | — | $770 | 0.42% |
| JEFF DALABA3 Filed as: JEFF CLACK | 4215 BOULDER CT. GIG HARBOR, WA 98332 | CONTINENTAL AMERICAN INSURANCE COMPANY | $451 | — | $451 | 0.25% |
| BARRY G WIEBE3 Filed as: BARRY G. WIEBE | 5479 SUNDOWN VIEW TERRACE BELLINGHAM, WA 98226 | CONTINENTAL AMERICAN INSURANCE COMPANY | $391 | — | $391 | 0.21% |
| LISA R PETERS3 Filed as: LISA R. PETERS | 1932 E. COLLEGE WAY STE. B ARLINGTON, WA 98223 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | — | $34 | 0.02% |
| HOLLY HALL3 | 2545 E SUNDOWN DR. COEUR D ALENE, ID 83815 | CONTINENTAL AMERICAN INSURANCE COMPANY | $33 | — | $33 | 0.02% |
| DAVID BRUNSON3 | 5378 DUSTY LANE BURLINGTON, WA 98233 | CONTINENTAL AMERICAN INSURANCE COMPANY | $20 | — | $20 | 0.01% |
| CYNTHIA MARIE SIMS3 | 10015 126TH ST. E. PUYALLUP, WA 98373 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF WASHINGTON, LLC | 1325 4TH AVE. STE. 2100 SEATTLE, WA 98101 | AMERITAS LIFE INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF WASHINGTON, LLC | 1325 4TH AVE. STE. 2100 SEATTLE, WA 98101 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $392 | $3K | 15.82% |
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 | 352 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 34 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 390 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 352 | $2.5M |
| Dental | DELTA DENTAL OF WASHINGTON | 341 | $275K |
| Vision | AMERITAS LIFE INSURANCE COMPANY | 295 | $32K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 21 | $20K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 21 | $20K |
| Prescription drug | PREMERA BLUE CROSS | 352 | $2.5M |
| Other(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 142 | $203K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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."
No prospect flags tripped on this filing.