| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $4K | $0 | $4K | 0.39% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | DELTA DENTAL OF WASHINGTON | $9K | $0 | $9K | 8.05% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $603 | $2K | 2.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203588 DALLAS, TX 75320 | VISION SERVICE PLAN | $361 | $0 | $361 | 3.26% |
| MASTERCARE SOLUTIONS, INC.3 | 10300 SW GREENBURG ROAD, SUITE 380 PORTLAND, OR 97223 | METROPOLITAN LIFE INSURANCE COMPANY | $408 | $0 | $408 | 3.79% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $186 | $0 | $186 | 1.73% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS, INC. | 1125 NW COUCH STREET, SUITE 900 PORTLAND, OR 97209 | METROPOLITAN LIFE INSURANCE COMPANY | $119 | $0 | $119 | 1.11% |
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 | 153 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 189 | $1.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 219 | $116K |
| Vision | VISION SERVICE PLAN | 155 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 143 | $74K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 143 | $74K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 143 | $74K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 189 | $1.1M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 143 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.