| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHARLES LEE FITCH, LTD.3 Filed as: CHARLES LEE FITCH LTD | PO BOX 158 MOUNTLAKE TERRACE, WA 98043 | GROUP HEALTH OPTIONS, INC. | $20K | — | $20K | 2.25% |
| CHARLES LEE FITCH, LTD.3 Filed as: CHARLES LEE FITCH LTD | PO BOX 158 MOUNTLAKE TERRACE, WA 98043 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 2.02% |
| CHARLES LEE FITCH, LTD.3 Filed as: CHARLES LEE FITCH LTD | PO BOX 158 MOUNTLAKE TERRACE, WA 98043 | DELTA DENTAL OF WASHINGTON | $739 | — | $739 | 1.48% |
| CHARLES LEE FITCH, LTD.3 Filed as: CHARLES LEE FITCH LTD | PO BOX 158 MOUNTLAKE TERRACE, WA 98043 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 84.11% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $72 | $72 | 1.87% |
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HEALTH OPTIONS, INC. | 249 | $894K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 290 | $140K |
| Vision | GROUP HEALTH OPTIONS, INC. | 249 | $894K |
| Life insurance(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 211 | $44K |
| Long-term disability(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 211 | $42K |
| Prescription drug | GROUP HEALTH OPTIONS, INC. | 249 | $894K |
| Other(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 211 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.