| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO | 601 UNION ST STE 1000 SEATTLE, WA 98101 | SYMETRA LIFE INSURANCE COMPANY | $0 | $9K | $9K | 3.71% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | — | HCC LIFE INSURANCE COMPANY | $0 | $9K | $9K | 4.00% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO | 601 UNION ST STE 1000 SEATTLE, WA 98101 | SYMETRA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 4.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSOR | Claims processing Service code 12 | — | $560K |
| USI INSURANCE SERVICES LLC. EIN 13-3771734 BROKER | Other commissions Service code 55 | — | $170K |
| VAN NOY CONSULTING FROUP CONSULTING | Consulting (general) Service code 16 | 2312 PROMETHEUS CT HENDERSON, NV 89074 | $77K |
| DELTA DENTAL OF WASHINGTON EIN 91-0621480 CLAIM PROCESSOR DENTAL | Other services; Claims processing Service code 12 | — | $18K |
| VISION SERVICE PLAN EIN 23-7089688 CLAIM PROCESSOR VISION | Other services; Claims processing Service code 12 | — | $12K |
| RXBENEFITS, INC. PHARMACY BENEFIT MANAGER | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $9K |
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 | 906 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 909 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 906 | $238K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 906 | $238K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 906 | $238K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE CO. | 962 | $474K |
| Other(2 contracts) | SYMETRA LIFE INSURANCE COMPANY | 906 | $313K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 962 | — |
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.