| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | HARTFORD LIFE AND ACCIDENT | $14K | — | $14K | 10.10% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HARTFORD LIFE AND ACCIDENT | — | $8K | $8K | 5.56% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $2K | — | $2K | 3.50% |
| DAVID ROJAS3 | 169 EAGLE RIDGE DRIVE E PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 4.30% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 3.12% |
| KYONG H. GOINS3 Filed as: KYONG H GOINS | 7711 27TH AVENUE SW SEATTLE, WA 98126 | CONTINENTAL AMERICAN INSURANCE COMPANY | $372 | — | $372 | 0.75% |
| JEFF DALABA3 Filed as: JEFF CLACK | 4215 BOULDER COURT GIG HARBOR, WA 98332 | CONTINENTAL AMERICAN INSURANCE COMPANY | $127 | — | $127 | 0.26% |
| CLACK ATTACK AGENCY, LLC3 | 949 MARKET STREET, SUITE 542 TACOMA, WA 98402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $102 | — | $102 | 0.21% |
| TRISHAWNA SCOTT HAYES3 Filed as: TRISHAWNA Y SCOTT-HAYES | 12014 133 ROAD STREET E, SUITE 301 PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INSURANCE COMPANY | $80 | — | $80 | 0.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BLUE CROSS EIN 91-0499247 ADMINISTRATOR | Contract Administrator Service code 13 | — | $103K |
| SUN LIFE ASSURANCE CO. OF CANADA EIN 38-1082080 ADMINISTRATOR | Contract Administrator Service code 13 | — | $21K |
| THE HARFORD EIN 06-0838648 ADMINISTRATOR | Contract Administrator Service code 13 | — | $18K |
| CURALINC HEALTHCARE EIN 33-1206383 ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| NAVIA BENEFIT SOLUTIONS EIN 91-1467758 ADMINISTRATOR | Contract Administrator Service code 13 | — | $14K |
| LOCKTON COMPANIES, LLC BROKER | Insurance agents and brokers Service code 22 | 444 WEST 47TH ST., 900 KANSAS CITY, MO 64112 | $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 | 581 | 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) | 581 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 406 | $56K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 674 | $138K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 674 | $138K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 674 | $188K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 674 | — |
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.