| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | PREMERA BLUE CROSS | — | $108K | $108K | 0.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | SYMETRA LIFE INSURANCE COMPANY | $49K | $27K | $76K | 7.24% |
| CONNEXION INSURANCE SOLUTIONS3 | 9725 3RD AVENUE NE, SUITE 110 SEATTLE, WA 98115 | SYMETRA LIFE INSURANCE COMPANY | $51K | $0 | $51K | 4.92% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | SYMETRA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 0.35% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | DELTA DENTAL OF WASHINGTON | $47K | $0 | $47K | 5.20% |
No Schedule C service providers reported on this filing.
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 | 901 | 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) | 901 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 1,698 | $14.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 1,788 | $907K |
| Vision | VISION SERVICE PLAN | 865 | $91K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 901 | $1.0M |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 901 | $1.0M |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 901 | $1.0M |
| Prescription drug | PREMERA BLUE CROSS | 1,698 | $14.1M |
| Other | SYMETRA LIFE INSURANCE COMPANY | 901 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,788 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.