| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | PACIFICSOURCE HEALTH PLANS | $40K | $0 | $40K | 4.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3144 SPOKANE, WA 99220 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | $0 | $4K | 5.85% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 WEST ERIE STREET, SUITE 300 CHICAGO, IL 60654 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $0 | $1K | 1.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | VISION SERVICE PLAN | $696 | $0 | $696 | 7.81% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 WEST ERIE STREET, SUITE 300 CHICAGO, IL 60654 | VISION SERVICE PLAN | $45 | $0 | $45 | 0.50% |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 148 | $894K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 160 | $73K |
| Vision | VISION SERVICE PLAN | 99 | $9K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 160 | $73K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 148 | $894K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 160 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.