| 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 | 3.25% |
| R.L. EVANS COMPANY, INC.3 | 3535 FACTORIA BLVD SE STE 120 BELLEVUE, WA 98006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| R.L. EVANS COMPANY, INC.3 | 3535 FACTORIA BLVD SE STE 120 BELLEVUE, WA 98006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| R.L. EVANS COMPANY, INC.3 Filed as: R. L. EVANS COMPANY, INC. | 3535 FACTORIA BLVD SE STE 120 BELLEVUE, WA 98006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $889 | — | $889 | 15.00% |
| R.L. EVANS COMPANY, INC.3 | 3535 FACTORIA BLVD SE STE120 BELLEVUE, WA 98006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $561 | — | $561 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| R.L. EVANS COMPANY, INC. EIN 91-0849754 BROKER | Insurance agents and brokers Service code 22 | — | $20K |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMIN | Other services; Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator Service code 12 | — | $10K |
| CIGNA HEALTH & LIFE INSURANCE | Direct payment from the plan; Participant communication; Claims processing; Non-monetary compensation; Other services; Float revenue; Contract Administrator; Named fiduciary Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO | Direct payment from the plan; Non-monetary compensation; Named fiduciary; Other services; Claims processing; Participant communication; Contract Administrator; Float revenue Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO. | Named fiduciary; Float revenue; Claims processing; Other services; Participant communication; Direct payment from the plan; Contract Administrator; Non-monetary compensation 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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WASHINGTON | 116 | $87K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 110 | $4K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 86 | $12K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 28 | $6K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 32 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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.