| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS WEST INC3 Filed as: BENEFITS WEST INC. | 19707 44TH AVE W STE 201 LYNNWOOD, WA 98036 | HARTFORD LIFE AND ACCIDENT | $8K | — | $8K | 10.00% |
| BENEFITS WEST INC3 Filed as: BENEFITS WEST | 19707 44TH AVE W STE 201 LYNNWOOD, WA 98036 | VSP | $2K | — | $2K | 3.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SHASTA ADMINISTRATIVE SERVICES NONE | Claims processing Service code 12 | 2751 SW AIRPORT WAY REDMOND, OR 97756 | $68K |
| BENEFITS WEST INC EIN 91-2152589 NONE | Insurance agents and brokers Service code 22 | — | $39K |
| FHN EIN 91-1272766 NONE | Contract Administrator; Claims processing Service code 12 | — | $8K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 NONE | Claims processing Service code 12 | — | $5K |
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 | 190 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VSP | 194 | $43K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 190 | $81K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 190 | $81K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE | 201 | $279K |
| Other | HARTFORD LIFE AND ACCIDENT | 190 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.