| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | REGENCE BLUESHIELD | $19K | — | $19K | 1.51% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES | 1100 DEXTER AVENUE NORTH, SUITE 220 SEATTLE, WA 98109 | REGENCE BLUESHIELD | $16K | — | $16K | 1.31% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES | 1100 DEXTER AVENUE NORTH, SUITE 220 SEATTLE, WA 98109 | DELTA DENTAL OF WASHINGTON | $4K | — | $4K | 2.89% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | UNKNOWN SEATTLE, WA 98109 | DELTA DENTAL OF WASHINGTON | $3K | — | $3K | 2.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | VISION SERVICE PLAN | $503 | — | $503 | 5.01% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES | 1100 DEXTER AVENUE NORTH, SUITE 220 SEATTLE, WA 98109 | VISION SERVICE PLAN | $248 | — | $248 | 2.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | LIFEMAP ASSURANCE COMPANY | $568 | — | $568 | 6.76% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES | 1100 DEXTER AVENUE NORTH, SUITE 220 SEATTLE, WA 98109 | LIFEMAP ASSURANCE COMPANY | $210 | — | $210 | 2.50% |
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 | 167 | 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) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUESHIELD | 199 | $1.2M |
| Dental | DELTA DENTAL OF WASHINGTON | 182 | $124K |
| Vision | VISION SERVICE PLAN | 97 | $10K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 129 | $8K |
| Prescription drug | REGENCE BLUESHIELD | 199 | $1.2M |
| Other | LIFEMAP ASSURANCE COMPANY | 129 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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.