| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST | 3911 CASTLEVALE ROAD, SUITE 201 YAKIMA, WA 98902 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $13K | $13K | 3.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST | 3911 CASTLEVALE RD., STE. 201 YAKIMA, WA 98902 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $28K | $5K | $33K | 17.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSING | Claims processing Service code 12 | 150 W. WAUSAU AVE. WAUSAU, WI 54401 | $368K |
| CHINOOK WINDS CASINO RESORT EIN 93-1172959 SPONSOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Accounting (including auditing) Service code 10 | 1777 NW 44TH ST. LINCOLN CITY, WA 973675094 | $127K |
| CONOVER ALMOND VALLEY INS SERVICES EIN 35-2524649 BROKER | Other commissions Service code 55 | PO BOX 10088 YAKIMA, WA 98909 | $105K |
| BLUEBIRD CPAS EIN 26-1571066 AUDITOR | Accounting (including auditing) Service code 10 | 5585 KIETZKE LANE RENO, NV 89511 | $11K |
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 | 698 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 700 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | OREGON DENTAL SERVICES DBA DELTA DENTAL PLAN OF OREGON | 823 | $9K |
| Vision | VISION SERVICE PLAN | 700 | $14K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 883 | $580K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 883 | $395K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 883 | $395K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 1,342 | $577K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,342 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.