| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $147K | $0 | $147K | 0.22% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $167K | $0 | $167K | 2.69% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $85K | $0 | $85K | 2.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | WILLAMETTE DENTAL OF WASHINGTON, INC. | $45K | $0 | $45K | 2.75% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $47K | $0 | $47K | 10.76% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | $0 | $16K | 10.84% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $216 | $0 | $216 | 10.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTH CARE INSURANCE CO EIN 36-2739571 NONE | Claims processing; Other services Service code 12 | — | $567K |
| WILLAMETTE DENTAL EIN 91-0621480 NONE | Claims processing Service code 12 | — | $352K |
| NEW YORK LIFE INSURANCE CO EIN 06-0300370 NONE | Claims processing Service code 12 | — | $293K |
| DAVIS WRIGHT TREMAINE EIN 91-0839480 NONE | Legal Service code 29 | — | $195K |
| MERCER EIN 13-2834414 NONE | Actuarial Service code 11 | — | $43K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $31K |
| WAGEWORKS, INC EIN 94-3351864 NONE | Claims processing Service code 12 | — | $24K |
| WEX EIN 01-0526993 NONE | Claims processing Service code 12 | — | $23K |
| EXPRESS SCRIPTS EIN 41-1627938 NONE | Claims processing Service code 12 | — | $12K |
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 | 4,002 | 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) | 4,002 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 9,930 | $68.0M |
| Dental | WILLAMETTE DENTAL OF WASHINGTON, INC. | 2,928 | $1.6M |
| Vision | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 9,930 | $68.0M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $6.2M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $3.9M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 9,930 | $68.0M |
| Other(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $583K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,930 | — |
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.