| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R.L. EVANS COMPANY, INC.3 Filed as: R. L. EVANS COMPANY, INC. | 3535 FACTORIA BLVD SE #120 BELLEVUE, WA 98006 | DELTA DENTAL OF WASHINGTON | $3K | — | $3K | 3.20% |
| R.L. EVANS COMPANY, INC.3 Filed as: R. L. EVANS COMPANY, INC. | 3535 FACTORIA BLVD SE #120 BELLEVUE, WA 98006 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 16.62% |
| R.L. EVANS COMPANY, INC.3 | 3535 FACTORIA BLVD SE #120 BELLEVUE, WA 98006 | FIRST CHOICE EAP | $283 | — | $283 | 11.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMIN | Participant communication; Named fiduciary; Direct payment from the plan; Contract Administrator; Other services; Float revenue; Non-monetary compensation; Claims processing Service code 12 | — | $25K |
| R.L. EVANS COMPANY, INC. EIN 91-0849754 BROKER | Insurance agents and brokers Service code 22 | — | $21K |
| CIGNA HEALTH & LIFE INSURANCE CO | Contract Administrator; Direct payment from the plan; Other services; Named fiduciary; Claims processing; Non-monetary compensation; Participant communication; Float revenue Service code 12 | — | $0 |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WASHINGTON | 106 | $91K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $32K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $32K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $32K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 113 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 113 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.