| 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 | $16K | — | $16K | 0.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | 601 UNION STREET, STE 1000 SEATTLE, WA 98101 | NEW YORK LIFE INSURANCE COMPANY | $67K | — | $67K | 2.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VIA BENEFITS EIN 26-0775680 NONE | Claims processing Service code 12 | — | $174K |
| UNITED HEALTH CARE INSURANCE CO. EIN 36-2739571 NONE | Claims processing; Other services Service code 12 | — | $114K |
| DAVIS WRIGHT TREMAINE EIN 91-0839480 NONE | Legal Service code 29 | — | $41K |
| MERCER EIN 13-2834414 NONE | Actuarial Service code 11 | — | $18K |
| MOSS ADAMS LLP EIN 91-0189318 NONE | Accounting (including auditing) Service code 10 | — | $8K |
| EXPRESS SCRIPTS, INC. EIN 41-1627938 NONE | Claims processing Service code 12 | — | $6K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,695 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,695 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER PERMANENTE | 855 | $8.5M |
| Vision | KAISER PERMANENTE | 855 | $8.5M |
| Life insurance | NEW YORK LIFE INSURANCE COMPANY | 4,400 | $2.8M |
| Prescription drug | KAISER PERMANENTE | 855 | $8.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,400 | — |
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.