| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO | 4605 COLUMBUS ST ATTN CASH RECEIPTS VIRGINIA BEACH, VA 234622490 | LIFEWISE ASSURANCE COMPANY | — | $36K | $36K | 5.74% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | NORTHWEST-WASHINGTON PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 4.09% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-SEATTLE | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 13.56% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST DBA KIBBLE & PRENTICE | HOLDING CO 601 UNION ST STE 1000 SEATTLE, WA 98101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $699 | $265 | $964 | 7.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BLUE CROSS EIN 91-0499247 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $216K |
| KIBBLE & PRENTICE HOLDING CO BROKER | Insurance agents and brokers; Other commissions Service code 22 | 601 UNION STREET STE 1000 SEATTLE, WA 98101 | $156K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Plan Administrator Service code 14 | — | $17K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Plan Administrator Service code 14 | — | $4K |
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 | 698 | 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) | 698 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 698 | $34K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 698 | $210K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 698 | $88K |
| Stop-loss / reinsurancereinsurance | LIFEWISE ASSURANCE COMPANY | 755 | $635K |
| Other(12 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 698 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 755 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.