| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST, LLC | 12100 NE 195TH STREET SUITE 200 BOTHELL, WA 98011 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | — | $14K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST, LLC | 12100 NE 195TH STREET SUITE 200 BOTHELL, WA 98011 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 4.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 12100 NE 195TH STREET SUITE 200 BOTHELL, WA 98001 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 6.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUE SHIELD OF IDAHO EIN 82-0206874 CLAIMS PROCESSING PROVIDE | Float revenue; Claims processing; Direct payment from the plan Service code 12 | PO BOX 2998 TACOMA, WA 98401 | $299K |
| HUB INTERNATIONAL NORTHWEST, LLC EIN 91-2036015 CONSULTANT | Consulting (general) Service code 16 | PO BOX 3018 BOTHELL, WA 98041 | $70K |
| EMPLOYEE BENEFITS GROUP, INC EIN 46-1378575 TPA / CONSULTANTS | Consulting (general) Service code 16 | PO BOX 142117 SPOKANE VALLEY, WA 99214 | $3K |
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 | 502 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 502 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 502 | $97K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 505 | $75K |
| Stop-loss / reinsurancereinsurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,300 | $705K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,300 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.