| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | KAISER PERMANENTE | $83K | — | $83K | 0.20% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | KAISER PERMANENTE | $73K | — | $73K | 0.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | P.O. BOX 62949 VIRGINIA BEACH, VA 23466 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | $64K | $20K | $84K | 2.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | PO BOX 62949 VIRGINIA BEACH, VA 23466 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | $57K | $9K | $66K | 2.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | WILLAMETTE DENTAL, INC. | $64K | $159K | $223K | 10.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | $39K | $8K | $47K | 11.96% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | $10K | $2K | $12K | 11.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | $179 | $35 | $214 | 11.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTH CARE INSURANCE CO. EIN 36-2739571 NONE | Claims processing; Other services Service code 12 | — | $804K |
| CONNECTICUT GENERAL LIFE INSURANCE EIN 06-0303370 NONE | Claims processing Service code 12 | — | $248K |
| WASHINGTON DENTAL EIN 91-0621480 NONE | Claims processing Service code 12 | — | $241K |
| DAVIS WRIGHT TREMAINE EIN 91-0839480 NONE | Legal Service code 29 | — | $175K |
| MERCER EIN 13-2834414 NONE | Actuarial Service code 11 | — | $76K |
| CONEXIS EIN 20-0198855 NONE | Claims processing Service code 12 | — | $28K |
| AON EIN 22-2232264 NONE | Consulting (general) Service code 16 | — | $25K |
| EXPRESS SCRIPTS EIN 41-1627938 NONE | Claims processing Service code 12 | — | $20K |
| MOSS ADAMS LLP EIN 91-0189318 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| SPECTERA EIN 36-2739571 NONE | Claims processing Service code 12 | — | $7K |
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 | 5,437 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 88 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,525 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER PERMANENTE | 5,675 | $78.2M |
| Dental | WILLAMETTE DENTAL, INC. | 1,476 | $2.1M |
| Vision(2 contracts) | KAISER PERMANENTE | 5,675 | $78.2M |
| Life insurance(4 contracts) | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | 7,678 | $2.8M |
| Short-term disability | CONNECTICUT GENERAL LIFE INSURANCE COMPANY, A CIGNA COMPANY | 4,989 | $3.2M |
| Prescription drug(2 contracts) | KAISER PERMANENTE | 5,675 | $78.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,678 | — |
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.