| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $51K | $2K | $52K | 2.07% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 15.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $176 | $176 | 0.40% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $134 | $134 | 0.30% |
| PATRICK IAN WAGNER3 | 4580 PEBBLE BROOK LANE PLANO, TX 75093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $720 | $0 | $720 | 4.12% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NORTHWEST 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $146 | $0 | $146 | 0.84% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NORTHEAST 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $146 | $0 | $146 | 0.84% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $88 | $0 | $88 | 0.50% |
| CHRISTINE LYNN MORGESTER3 | 2137 NORTH Q STREET WASHOUGAL, WA 98671 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 0.36% |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.11% |
No Schedule C service providers reported on this filing.
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 | 450 | 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. |
| Total participants (= "Plan participants" tile) | 450 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 471 | $2.5M |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 450 | $62K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 471 | $2.5M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 450 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 471 | — |
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.