| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANTONIO JOSE ANGELES3 Filed as: ANTONIO MICHAEL JAIME | 24345 252ND AVE SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $16K | $6K | $22K | 11.73% |
| RICH IN BENEFITS INC3 | 13109 NE 123RD ST KIRKLAND, WA 98034 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $3K | $10K | 5.41% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 Filed as: DOUGLAS EDWARD VIESELMEYER | 14405 115TH AVE CT E PUYALLUP, WA 98374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $228 | $6K | 2.89% |
| ROBERT WILLIAM PLATTE3 | 15221 227TH AVE NE WOODINVILLE, WA 98077 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $87 | $3K | 1.78% |
| RONALD JONES3 | 320 NANCY CT MOSCOW, ID 83843 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $410 | $2K | 1.21% |
| HEATHER MARIE JONES3 | 6325 E 18TH AVE SPOKANE VALLEY, WA 99212 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $193 | $28 | $221 | 0.12% |
| MEGHAN B THOMPSON3 | 15703 NE 1ST PL BELLEVUE, WA 98008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $142 | — | $142 | 0.07% |
| DANIEL SHARP3 | 1911 98TH ST SE EVERETT, WA 98208 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $26 | $46 | 0.02% |
| CHRISTOPHER MICHAEL JONES3 | 6325 E 18TH AVE SPOKANE VALLEY, WA 99212 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $19 | $34 | 0.02% |
| CHRISTY BOONE3 | 9520 E WELLESLEY AVE SPOKANE, WA 99206 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $11 | $26 | 0.01% |
| DEANA SCHROEDER3 | 23115 120TH AVE SE KENT, WA 98031 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| ALLISON RENEE MOSER3 | 2211 HENRY STREET BELLINGHAM, WA 98225 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $2 | $6 | 0.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 10.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFEMAP ASSURANCE COMPANY | $3K | — | $3K | 6.90% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 10.51% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $867 | — | $867 | 10.00% |
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 | 276 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 276 | $84K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 261 | $190K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 241 | $36K |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 276 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 276 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.