| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | PREMERA BLUE CROSS | $48K | $15K | $64K | 3.21% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | UNKNOWN BELLEVUE, WA 98004 | DELTA DENTAL OF WASHINGTON | $7K | $0 | $7K | 4.58% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $3K | $16K | 11.22% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 7.79% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | PO BOX 8299 PASADENA, CA 91109 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.26% |
| AMERICAN BENEFITS & COMP SYSTEMS3 Filed as: AMERICAN BENEFITS & COMP SYS, INC. | 101 PARK AVENUE, 14TH FLOOR NEW YORK, NY 10178 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $640 | $0 | $640 | 3.77% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | FOUR EVER LIFE INSURANCE COMPANY | $635 | $0 | $635 | 15.01% |
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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 257 | $2.0M |
| Dental | DELTA DENTAL OF WASHINGTON | 255 | $146K |
| Vision | VISION SERVICE PLAN | 121 | $20K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $162K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $145K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $145K |
| Prescription drug | PREMERA BLUE CROSS | 257 | $2.0M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.