| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 6.55% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 3.74% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 W ERIE ST STE 300 CHICAGO, IL 60654 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 1.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 980413018 | VISION SERVICE PLAN | $604 | — | $604 | 3.56% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | VISION SERVICE PLAN | $404 | — | $404 | 2.38% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 W ERIE ST STE 300 CHICAGO, IL 60654 | VISION SERVICE PLAN | $85 | — | $85 | 0.50% |
| TRICIA CHARLES3 | 1118 W LINCOLN AVENUE SUITE B YAKIMA, WA 98902 | CONTINENTAL AMERICAN INSURANCE COMPANY | $401 | — | $401 | 6.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH SUITE 200 BOTHELL, WA 98011 | CONTINENTAL AMERICAN INSURANCE COMPANY | $361 | — | $361 | 6.03% |
| DAVID ROJAS3 | 169 EAGLE RIDGE DR STE E PUYALLUP, WA 98374 | CONTINENTAL AMERICAN INSURANCE COMPANY | $83 | — | $83 | 1.39% |
| DAVID JOSHUA ABDELAZIZ3 | 331 SADDLE LEAF CIBOLO, TX 78108 | CONTINENTAL AMERICAN INSURANCE COMPANY | $52 | — | $52 | 0.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BLUECROSS EIN 91-0499247 NONE | Contract Administrator Service code 13 | — | $105K |
| CU BENEFITS ALLIANCE EIN 93-0465543 NONE | Insurance agents and brokers Service code 22 | — | $38K |
| HUB INTERNATIONAL NORTHWEST LLC EIN 91-2036015 NONE | Contract Administrator Service code 13 | — | $3K |
| ALLEGIANCE BENEFIT EIN 81-0400550 NONE | Claims processing Service code 12 | — | $572 |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 117 | $17K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $85K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $85K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $85K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 143 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.