| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 2158 RIVERSIDE, CA 92516 | LIFEMAP ASSURANCE COMPANY | $557 | — | $557 | 3.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL LIMITED EIN 91-2306015 NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | PO BOX 3144 SPOKANE, WA 99201 | $91K |
| TAILORWELL HOLDINGS EIN 47-2419911 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Direct payment from the plan Service code 13 | 1631 15TH AVE W, SUITE 312 SEATTLE, WA 98119 | $24K |
| WASHINGTON CANNABUSINESS ASSOCIATIO EIN 46-4520800 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | PO BOX 9912 SEATTLE, WA 98102 | $22K |
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 | 262 | 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) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 107 | $876K |
| Dental | DELTA DENTAL OF WASHINGTON | 185 | $90K |
| Vision | LIFEMAP ASSURANCE COMPANY | 156 | $16K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 156 | $16K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 156 | $16K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 156 | $16K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 107 | $876K |
| Other | LIFEMAP ASSURANCE COMPANY | 156 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.