| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SYMETRA LIFE INSURANCE COMPANY | $14K | $0 | $14K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | WILLAMETTE DENTAL OF WASHINGTON, INC. | $6K | $0 | $6K | 10.70% |
| G SCOTT COOKE3 Filed as: SCOTT PETERSON | 21926 43RD DRIVE SE BOTHELL, WA 98021 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $143 | $285 | $428 | 3.22% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $214 | $0 | $214 | 1.61% |
| RANDALL LEE WALLACE3 | 17701 108TH AVENUE SE RENTON, WA 98055 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $109 | $3 | $112 | 0.84% |
| WHITFIELD BENEFIT SOLUTIONS3 | 341 WEST TUDOR ROAD ANCHORAGE, AK 99503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $94 | $0 | $94 | 0.71% |
| DOUGLAS EDWARD VIESELMEYER3 | 14405 115TH AVENUE COURT EAST PUYALLUP, WA 98374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $55 | $24 | $79 | 0.59% |
| MJ INSURANCE3 Filed as: DONALD T. GOTHAM AND VARIOUS AGENTS | 3129 ECLIPSE DRIVE GREEN BAY, WI 54311 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $56 | $5 | $61 | 0.46% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DRIVE SE OLYMPIA, WA 98501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $19 | $47 | 0.35% |
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 | 366 | 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) | 366 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | WILLAMETTE DENTAL OF WASHINGTON, INC. | 110 | $53K |
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 366 | $104K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 366 | $91K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 366 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 366 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.