| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 4.67% |
| PETER J MACE3 Filed as: PETER J. MACE | 5775 D GLENRIDGE DRIVE, SUITE 350 ATLANTA, GA 30328 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $490 | — | $490 | 0.24% |
| GREGORY J. HINE3 | 8118 62ND DRIVE NE MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11K | — | $11K | 8.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $123 | $4K | 2.80% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I. BUCHOLTZ | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $68 | $2K | 1.37% |
| BRATRUD MIDDLETON INSURANCE BROKERS3 | UNKNOWN TACOMA, WA 98402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.08% |
| BRIAN WHITE3 Filed as: BRIAN RODERICK | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $634 | $371 | $1K | 0.80% |
| MJ INSURANCE3 Filed as: PAM BRUNING AND VARIOUS AGENTS | 1430 WEST CASINO ROAD EVERETT, WA 98204 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $545 | — | $545 | 0.43% |
| RONNA BURGER3 | 1112 27TH STREET NW PUYALLUP, WA 98371 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $125 | $157 | $282 | 0.22% |
| PETER J MACE3 Filed as: PETER J. MACE | 5775 D GLENRIDGE DRIVE, SUITE 350 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 3.47% |
| GREGORY J. HINE3 Filed as: GREGORY HINE | 1106 COLUMBIA AVENUE MARYSVILLE, WA 98270 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $7 | $7 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $2 | $2 | 0.00% |
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 | 2,102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GROUP HEALTH OPTIONS, INC. | 2,063 | $16.2M |
| Dental(2 contracts, 2 carriers) | PREMERA BLUE CROSS | 1,075 | $1.2M |
| Vision | VISION SERVICE PLAN | 1,826 | $134K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,903 | $204K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 132 | $126K |
| Prescription drug(2 contracts, 2 carriers) | GROUP HEALTH OPTIONS, INC. | 2,063 | $16.2M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,102 | $312K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,102 | — |
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.
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.