| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | PREMERA BLUE CROSS | $56K | $6K | $62K | 5.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | WILLAMETTE DENTAL OF WASHINGTON, INC. | $2K | $0 | $2K | 3.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $45 | $3K | 5.09% |
| MJ INSURANCE3 Filed as: KYONG GOINS AND VARIOUS AGENTS | 7711 27TH AVENUE SOUTHWEST SEATTLE, WA 98126 | AFLAC | $661 | $0 | $661 | 4.99% |
| MICHAEL D SCHULTZ3 Filed as: MICHAEL T. PETTERSON | 203 NORTH CENTENNIAL STREET MOXEE, WA 98936 | AFLAC | $476 | $0 | $476 | 3.59% |
| PHILBERT E ORTEGA3 Filed as: PHILBERT E. ORTEGA | 15100 SOUTHEAST 38TH STREET SUITE 763 BELLEVUE, WA 98006 | AFLAC | $151 | $0 | $151 | 1.14% |
| MELISSA PAUL3 Filed as: MELISSA PUAL | PO BOX 8010 YAKIMA, WA 98908 | AFLAC | $114 | $0 | $114 | 0.86% |
| JAIME PEREZ3 | 21 CODY LANE SUNNYSIDE, WA 98944 | AFLAC | $104 | $0 | $104 | 0.79% |
| BRIAN W. BALMES3 | 757 HIGH VALLEY ROAD SELAH, WA 98942 | AFLAC | $103 | $0 | $103 | 0.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 415 NORTH 2ND STREET YAKIMA, WA 98901 | AFLAC | $98 | $0 | $98 | 0.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | VISION SERVICE PLAN | $549 | $0 | $549 | 9.85% |
| TOTAL BENEFIT SOLUTIONS3 | PO BOX 10448 YAKIMA, WA 98909 | VISION SERVICE PLAN | $549 | $0 | $549 | 9.85% |
| UNKNOWN3 | UNKNOWN YAKIMA, WA 98902 | VISION SERVICE PLAN | -$100K | $0 | -$100K | -1794.99% |
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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 143 | $1.1M |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL OF WASHINGTON, INC. | 132 | $108K |
| Vision | VISION SERVICE PLAN | 55 | $6K |
| Life insurance | AFLAC | 18 | $13K |
| Short-term disability | AFLAC | 18 | $13K |
| Prescription drug | PREMERA BLUE CROSS | 143 | $1.1M |
| Other | AFLAC | 18 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.