| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | PREMERA BLUE CROSS | $47K | $9K | $56K | 3.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | DELTA DENTAL OF WASHINGTON | $8K | — | $8K | 4.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 10.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 2.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $408 | $408 | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | VISION SERVICE PLAN | $2K | — | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $836 | $11 | $847 | 5.49% |
| RENEE LOUISE ROBERTSON3 | 28022 231ST PLACE SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $640 | $27 | $667 | 4.32% |
| MODERN BENEFITS SOLUTIONS INC3 Filed as: MODERN BENEFITS SOLUTIONS, INC. | 2414 SOUTH KATY COURT SPOKANE, WA 99224 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $541 | — | $541 | 3.50% |
| KENT ANTHONY SHERMAN3 | 19230 LAKE FRANCIS ROAD SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $67 | $94 | 0.61% |
| RONNEL BATTS3 | 5424 WEST HOFFMAN PLACE SPOKANE, WA 99205 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.41% |
| MJ INSURANCE3 Filed as: MARK C. MORGAN AND VARIOUS AGENTS | 2590 WILLAMETTE DRIVE NE LACEY, WA 98516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $30 | $21 | $51 | 0.33% |
| LAURABETH CHRISTENSEN3 | 4824 186TH PLACE WEST LYNNWOOD, WA 98037 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $9 | $14 | 0.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $779 | $38 | $817 | 26.23% |
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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 237 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PREMERA BLUE CROSS | 205 | $1.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF WASHINGTON | 345 | $187K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 207 | $33K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 235 | $113K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 235 | $80K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 235 | $80K |
| Prescription drug(2 contracts, 2 carriers) | PREMERA BLUE CROSS | 205 | $1.6M |
| Other(4 contracts, 4 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 235 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 345 | — |
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.