| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAEL & LETSON3 | 419 OCCIDENTAL AVE S STE 304 SEATTLE, WA 98104 | PRINCIPAL LIFE INSURANCE CO. | $2K | $243 | $2K | 7.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS EIN 91-0680697 NONE | Accounting (including auditing); Investment management fees paid directly by plan; Investment management; Contract Administrator Service code 10 | — | $10.2M |
| CIGNA EIN 59-1031071 NONE | Contract Administrator; Direct payment from the plan; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $5.3M |
| MEDIMPACT HEALTHCARE SYSTEMS, INC. EIN 33-0567651 NONE | Direct payment from the plan; Claims processing; Other services Service code 12 | — | $957K |
| DELTA DENTAL OF WASHINGTON EIN 91-0621480 NONE | Claims processing; Insurance services Service code 12 | — | $901K |
| GROUP HEALTH OPTIONS EIN 91-1467158 NONE | Claims processing; Plan Administrator; Direct payment from the plan Service code 12 | — | $687K |
| WASHINGTON HEALTH ALLIANCE EIN 47-0948895 NONE | Other fees Service code 99 | — | $141K |
| RAEL & LETSON EIN 94-1701048 NONE | Insurance agents and brokers; Consulting (general) Service code 16 | — | $134K |
| STAYWELL HEALTH MANAGEMENT EIN 13-2890345 NONE | Other services Service code 49 | — | $109K |
| WELLS FARGO INSURANCE SERVICES EIN 56-1882208 NONE | Insurance agents and brokers Service code 22 | — | $80K |
| SERVICE PRINTING CO., INC. EIN 91-0830372 NONE | Copying and duplicating Service code 36 | — | $71K |
| AUKEMA & ASSOCIATES EIN 20-2023367 NONE | Participant communication Service code 38 | — | $65K |
| OPTUM NONE | Consulting (general) Service code 16 | 1021 WIND CROSS CT FRANKLIN, TN 37061 | $52K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $49K |
| REID, MCCARTHY, BALLEW & LEAHY, LLP EIN 91-0749971 NONE | Legal Service code 29 | — | $48K |
| CAPITOL CITY PRESS EIN 91-1068832 NONE | Other services; Copying and duplicating Service code 36 | — | $45K |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $45K |
| LEGEND DATA SYSTEMS, INC. NONE | Copying and duplicating Service code 36 | PO BOX 88787 SEATTLE, WA 98138 | $23K |
| MEDICAL REVIEW INSTITUTE OF AMERICA NONE | Consulting (general) Service code 16 | 2875 S DECKER LAKE DR STE 300 SALT LAKE CITY, UT 84119 | $16K |
| STATE STREET CORPORATION EIN 04-1867445 NONE | Custodial (securities); Accounting (including auditing); Custodial (other than securities) Service code 10 | — | $14K |
| KAYE-SMITH NONE | Copying and duplicating Service code 36 | 4101 OAKESDALE AVE SW RENTON, WA 98057 | $9K |
| K&H INTEGRATED PRINT SOLUTIONS NONE | Copying and duplicating Service code 36 | PO BOX 388 EVERETT, WA 98206 | $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 | 19,178 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 19,178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | PRINCIPAL LIFE INSURANCE CO. | 31,328 | $810K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 31,328 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.