| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS A WOHLMAN INC.3 Filed as: DOUGLAS WOHLMAN INC | 809 ALOHA STREET EDMONDS, WA 98020 | THE UNION LABOR LIFE INSURANCE COMPANY | — | $15K | $15K | — |
| THE SEGAL COMPANY3 | 333 W 34TH STREET NEW YORK, NY 10001 | THE UNION LABOR LIFE INSURANCE COMPANY | — | $6K | $6K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Non-monetary compensation; Float revenue; Claims processing; Other services; Contract Administrator; Direct payment from the plan; Participant communication; Named fiduciary Service code 12 | — | $743K |
| BENESYS INC EIN 38-2383171 NONE OTHER THAN CONTRACT | Copying and duplicating; Contract Administrator Service code 13 | — | $668K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Insurance agents and brokers; Accounting (including auditing) Service code 10 | — | $287K |
| DELTA DENTAL INSURANCE CO EIN 94-2761537 NONE OTHER THAN CONTRACT | Plan Administrator; Claims processing Service code 12 | — | $81K |
| US BANK TRUST CO EIN 93-6157747 NONE OTHER THAN CONTRACT | Custodial (securities) Service code 19 | — | $69K |
| KAY PRINTING NONE OTHER THAN CONTRACT | Copying and duplicating; Other services Service code 36 | 220 ENTIN RD CLIFTON, NJ 07014 | $54K |
| SALTZMAN & JOHNSON NONE | Legal Service code 29 | 7 W 41ST AVE STE 410 SAN MATEO, CA 94403 | $48K |
| GALLAGHER FIDUCIARY ADVISORS LLC EIN 36-4291971 NONE | Investment advisory (plan) Service code 27 | — | $30K |
| SEGAL SELECT INSURANCE EIN 46-0169194 NONE | Insurance services Service code 23 | — | $24K |
| IRON MOUNTAIN NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 929 S MEDINA ST SAN ANONIO, TX 78207 | $17K |
| BALDWIN MOFFITT BEHM LLP EIN 46-4370753 NONE | Accounting (including auditing) Service code 10 | — | $16K |
| SEGAL BENZ NONE OTHER THAN CONTRACT | Consulting (general) Service code 16 | 275 9TH STREET SAN FRANCISCO, CA 94105 | $11K |
| SMART SOURCE LLC EIN 54-2104343 NONE | Other services Service code 49 | — | $5K |
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 | 1,802 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,802 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 1,802 | $0 |
| Dental | DELTA DENTAL INSURANCE COMPANY | 1,802 | $0 |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,802 | $0 |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,802 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,802 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.