| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | REGENCE BLUESHIELD | $16K | $2K | $18K | 2.85% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNION SECURITY INSURANCE COMPANY | $2K | $0 | $2K | 3.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNION SECURITY INSURANCE COMPANY | $1K | $492 | $2K | 10.48% |
| CALLIS AND ASSOCIATES, INC.3 | 806 SOUTH VINE STREET PORT ANGELES, WA 98362 | UNION SECURITY INSURANCE COMPANY | $933 | $0 | $933 | 6.03% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $984 | $2K | 26.49% |
| ROXANA BUSCHMAN3 | 400 NE 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $81 | $1K | 16.07% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $485 | $244 | $729 | 9.59% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $304 | $173 | $477 | 6.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 700 NE MULTNOMAH STREET, SUITE 1300 PORTLAND, OR 97232 | VISION SERVICE PLAN | $620 | $0 | $620 | 8.34% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | SUN LIFE AND HEALTH INSURANCE COMPANY | $751 | $0 | $751 | 13.59% |
| HELD SERVICES LLC3 | UNKNOWN PORT ANGELES, WA 98362 | SUN LIFE AND HEALTH INSURANCE COMPANY | $122 | $0 | $122 | 2.21% |
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 | 104 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD | 81 | $619K |
| Dental | UNION SECURITY INSURANCE COMPANY | 87 | $62K |
| Vision | VISION SERVICE PLAN | 86 | $7K |
| Life insurance | UNION SECURITY INSURANCE COMPANY | 94 | $15K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 19 | $6K |
| Prescription drug | REGENCE BLUESHIELD | 81 | $619K |
| Other(3 contracts, 3 carriers) | UNION SECURITY INSURANCE COMPANY | 104 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.