| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON Filed as: RAEL AND LETSON | 601 UNION ST STE 2415 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $23K | — | $23K | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUESHIELD EIN 91-0282080 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $3.4M |
| DELTA DENTAL OF WASHINGTON EIN 91-0621480 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $814K |
| EXPRESS SCRIPT, INC EIN 22-3461740 NONE | Direct payment from the plan; Other services Service code 49 | — | $437K |
| CLISE AGENCY EIN 91-6024838 NONE | Direct payment from the plan; Other services Service code 49 | — | $385K |
| WELLINGTON MANAGEMENT COMPANY EIN 04-2683227 NONE | Direct payment from the plan; Investment management fees paid directly by plan; Soft dollars commissions Service code 50 | — | $352K |
| EMPLOYEE 01 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $344K |
| EMPLOYEE 02 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $332K |
| FIRST CHOICE HEALTH CENTERS INC. EIN 06-1416492 NONE | Direct payment from the plan; Other services Service code 49 | — | $238K |
| BASYS EIN 52-1796473 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $217K |
| EMPLOYEE 03 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $205K |
| EMPLOYEE 04 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $201K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | — | $195K |
| BARLOW COUGHRAN MORALES & JOSEPHSON EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $190K |
| EMPLOYEE 09 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $182K |
| EMPLOYEE 12 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $173K |
| EMPLOYEE 08 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $166K |
| EMPLOYEE 34 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $165K |
| EMPLOYEE 16 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $164K |
| VISION SERVICE PLAN EIN 23-7089668 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $162K |
| EMPLOYEE 13 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $159K |
| EMPLOYEE 35 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $150K |
| ANASTASI MOORE & MARTIN PLLC EIN 20-8149084 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $148K |
| CHANGE HEALTHCARE NONE | Copying and duplicating; Other services Service code 36 | PO BOX 572490 MURRAY, UT 84157 | $145K |
| EMPLOYEE 15 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $135K |
| EMPLOYEE 81 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $133K |
| EMPLOYEE 92 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $129K |
| EMPLOYEE 58 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $128K |
| EMPLOYEE 21 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $120K |
| EMPLOYEE 29 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $115K |
| EMPLOYEE 24 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $113K |
| EMPLOYEE 19 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $113K |
| EMPLOYEE 39 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $104K |
| EMPLOYEE 47 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $103K |
| EMPLOYEE 32 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $103K |
| EMPLOYEE 36 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $98K |
| EMPLOYEE 46 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $93K |
| EMPLOYEE 54 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $92K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $91K |
| EMPLOYEE 86 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $90K |
| EMPLOYEE 82 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $90K |
| EMPLOYEE 37 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $90K |
| EMPLOYEE 22 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $89K |
| EMPLOYEE 31 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $87K |
| EMPLOYEE 52 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $83K |
| EMPLOYEE 91 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $80K |
| EMPLOYEE 61 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| EMPLOYEE 53 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $77K |
| EMPLOYER 42 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $77K |
| EMPLOYEE 33 EIN 91-6029049 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $76K |
| EMPLOYEE 20 EIN 91-6029049 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $76K |
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 | 14,033 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,773 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 15,806 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 2,919 | $11.9M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 15,434 | $1.5M |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 15,434 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 15,434 | — |
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.