| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | REGENCE BLUESHIELD | — | $11K | $11K | 0.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES,INC. | 777 108TH AVENUE, SUITE 200 BELLEVUE, WA 98004 | SUN LIFE ASSURANCE COMPANY OF CANADA | $32K | — | $32K | 15.92% |
| MEDICAL GROUP INSURANCE SERVICES5 Filed as: MEDICAL GROUP INS. SERVICES, INC. | 1849 WEST NORTH TEMPLE SALT LAKE CITY, UT 84116 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $180 | $180 | 0.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $337 | $337 | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $49 | $1K | 25.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | LIFEMAP ASSURANCE COMPANY | $507 | — | $507 | 11.63% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 2.85% |
| GREGORY J. HINE3 | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 1.60% |
| JOEL N NEWMAN AGENCY LLC3 Filed as: JOEL N. NEWMAN AGENCY LLC | 7808 SE 28TH STREET MERCER ISLAND, WA 98040 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 1.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 1.00% |
| WHITFIELD BENEFIT SOLUTIONS3 | 341 WEST TUDOR ROAD ANCHORAGE, AK 99503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.70% |
| DONALD J. PEOPLES3 | 42617 SE 169TH STREET NORTH BEND, WA 98045 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.55% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517 217TH AVENUE, COURT E BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.15% |
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 | 460 | 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) | 463 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD | 311 | $2.5M |
| Dental | DELTA DENTAL OF WASHINGTON | 375 | $228K |
| Vision | VISION SERVICE PLAN | 277 | $18K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 367 | $228K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 367 | $201K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 367 | $201K |
| Prescription drug | REGENCE BLUESHIELD | 311 | $2.5M |
| Other(5 contracts, 5 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 473 | $235K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 473 | — |
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.