| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS WEST INC3 | 19707 44TH AVE WEST, SUITE 201 LYNNWOOD, WA 98036 | DELTA DENTAL OF WASHINGTON | $32K | $0 | $32K | 2.76% |
| BENEFITS WEST INC3 | 19707 44TH AVE WEST SUITE201 LYNNWOOD, WA 98036 | HM LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| BENEFITS WEST INC3 | 19707 44TH AVENUE WEST, STE 201 LYNNWOOD, WA 98036 | GROUP HEALTH COOPERATIVE | $18K | $0 | $18K | 2.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCARE MANAGEMENT ADMINISTRATOR EIN 91-1333840 NONE | Contract Administrator Service code 13 | 220 120TH AVE NE BELLEVUE, WA 98005 | $501K |
| BENEFITS WEST INC EIN 91-2152589 NONE | Insurance agents and brokers Service code 22 | 19707 44TH AVE WEST, SUITE 201 LYNNWOOD, WA 98036 | $137K |
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 | 1,806 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,832 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HEALTH COOPERATIVE | 124 | $627K |
| Dental | DELTA DENTAL OF WASHINGTON | 2,615 | $1.1M |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 1,430 | $746K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,615 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.