| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NANCY A. KOKENGE3 | UNKNOWN YAKIMA, WA 98902 | REGENCE BLUESHIELD | $0 | $167 | $167 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | STANDARD INSURANCE COMPANY | $4K | $391 | $4K | 6.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | STANDARD INSURANCE COMPANY | $0 | $548 | $548 | 0.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $211 | $3K | 9.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 15.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $254 | $254 | 1.14% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | VISION SERVICE PLAN | $972 | $0 | $972 | 10.00% |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD | 96 | $823K |
| Dental | STANDARD INSURANCE COMPANY | 107 | $59K |
| Vision | VISION SERVICE PLAN | 89 | $10K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 127 | $53K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 127 | $30K |
| Prescription drug | REGENCE BLUESHIELD | 96 | $823K |
| Other(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 127 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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.