| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $143 | $143 | 0.07% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $318 | $318 | 2.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WASHINGTON EIN 91-0621480 CLAIMS PROCESSING | Contract Administrator Service code 13 | — | $207K |
| ESI EIN 22-3461740 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $26K |
| PREMERA BLUE CROSS EIN 91-0499247 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $26K |
| MATRIX ABSENCE MANAGEMENT, INC. EIN 77-0493584 NONE | Claims processing Service code 12 | — | $17K |
| ALLIANT INSURANCE SERVICES INC BROKER | Insurance agents and brokers Service code 22 | 1420 5TH AVE STE 1500 SEATTLE, WA 98101 | $6K |
| VEBTEGRA EIN 38-3713042 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $499 |
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 | 691 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 693 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PREMERA BLUE CROSS | 876 | $456K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 9 | $180K |
| Vision(2 contracts, 2 carriers) | PREMERA BLUE CROSS | 876 | $456K |
| Life insurance(3 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 721 | $659K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 721 | $269K |
| Other(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 709 | $209K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 876 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.