| 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 | — | $34K | $34K | 4.22% |
| USI INSURANCE SERVICES LLC3 | WEST-SAN FRANCISCO PO BOX 66119 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 21.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.57% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | NORTHWEST-WASHINGTON PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $419 | — | $419 | 1.00% |
| 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 | 12.85% |
| 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 | $614 | $138 | $752 | 6.04% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $78 | $78 | 0.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BLUE CROSS EIN 91-0499247 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $259K |
| HUB INTERNATIONAL MIDWEST BROKER | Other commissions; Insurance agents and brokers Service code 22 | 15162 COLLECTIONS DR CHICAGO, IL 606930001 | $139K |
| KIBBLE & PRENTICE HOLDING CO BROKER | Insurance agents and brokers; Other commissions Service code 22 | 601 UNION STREET STE 1000 SEATTLE, WA 98101 | $45K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Plan Administrator Service code 14 | — | $20K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Plan Administrator Service code 14 | — | $6K |
| KIBBLE & PRENTICE HOLDING COMPANY BROKER | Insurance agents and brokers; Other commissions Service code 22 | 601 UNION STREET STE 1000 SEATTLE, WA 98101 | $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 | 806 | 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) | 806 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 806 | $42K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 806 | $105K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 806 | $110K |
| Stop-loss / reinsurancereinsurance | LIFEWISE ASSURANCE COMPANY | 821 | $798K |
| Other(12 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 806 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 821 | — |
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.