| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WASHINGTON | 1501 FOURTH AVENUE STE 400 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | — | $13K | 17.20% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON | 1501 FOURTH AVENUE STE 2400 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $982 | — | $982 | 17.21% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WASHINGTON | 1501 FOURTH AVENUE STE 2400 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $321 | — | $321 | 17.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BROWN AND BROWN OF WA EIN 91-0378940 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $96K |
| BENEFIT PLANS ADMIN SERVICES INC EIN 16-1503696 NONE | Trustee (discretionary); Recordkeeping and information management (computing, tabulating, data processing, etc.); Investment advisory (participants); Custodial (securities); Other fees; Other investment fees and expenses; Sub-transfer agency fees Service code 15 | — | $48K |
| BENEFIT SOLUTIONS INC EIN 91-1603312 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $30K |
| WELFARE AND PENSION ADMIN SERVICES EIN 91-1363171 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $17K |
| MCKENZIE, ROTHWELL, BARLOW, P.S. EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $15K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $14K |
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 | 305 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 172 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 477 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WASHINGTON | 346 | $441K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 167 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $77K |
| Stop-loss / reinsurancereinsurance | LIFEWISE ASSURANCE COMPANY | 385 | $496K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 167 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.