| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROPEL INSURANCE3 | 1201 PACIFIC AVE. 1000 TACOMA, WA 98402 | FIDELITY SECURITY LIFE INSURANCE CO. | $38K | — | $38K | 9.09% |
| INTERREMEDY INSURANCE SERVICES3 Filed as: INTERREMEDY INSURANCE SERVICE LLC | 315 MONTGOMERY ST 900 SAN FRANCISCO, CA 94104 | FIDELITY SECURITY LIFE INSURANCE CO. | $21K | — | $21K | 5.05% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL | 4851 LBJ FRWY SUITE 100 DALLAS, TX 75244 | SYMETRA LIFE INSURANCE CO. | — | $1K | $1K | 3.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 2323 EASTLAKE AVE. E SEATTLE, WA 981023305 | $682K |
| PREMERA EIN 91-0499247 PPO ACESS, CLAIMS ADMIN. | Claims processing Service code 12 | PO BOX 327 SEATTLE, WA 98111 | $377K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 CLAIMS AUDITING | Direct payment from the plan; Insurance services; Other services Service code 23 | PO BOX 22386 PORTLAND, OR 97269 | $74K |
| US BANK EIN 93-0571729 CUSTODIAN, INVESTMENT MGR | Investment management; Custodial (securities) Service code 19 | 800 NICOLLET MALL MINNEAPOLIS, MN 55402 | $51K |
| PROPEL INSURANCE EIN 91-0830024 CONSULTANT | Insurance agents and brokers; Consulting (general) Service code 16 | 925 FOURTH AVENUE 3200 SEATTLE, WA 981041159 | $43K |
| UNITED CLAIM SOLUTIONS, LLC EIN 20-0908354 CLAIMS PRICING | Claims processing Service code 12 | PO BOX 1007 CALDWELL, ID 83606 | $42K |
| MCKENZIE ROTHWELL BARLOW & COUGHRAN EIN 91-1008931 LEGAL COUNCEL | Legal Service code 29 | 500 UNION SQUARE, 700 SEATTLE, WA 981012386 | $22K |
| BJORKLUND & MONTPLAISIR EIN 93-1015766 AUDITOR | Accounting (including auditing) Service code 10 | 9020 SW WASHINGTON SQ RD PORTLAND, OR 97223 | $13K |
| ANASTASI, MOORE AND MARTIN EIN 20-8149084 PAYROLL AUDITOR | Accounting (including auditing) Service code 10 | 104 S DIVISION SPOKANE, WA 99202 | $10K |
| MILLIMAN USA EIN 91-0675641 ACTUARY | Actuarial Service code 11 | 1301 FIFTH AVENUE, 3800 SEATTLE, WA 981012646 | $8K |
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 | 1,535 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 168 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,703 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE CO. | 1,535 | $27K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE CO. | 1,621 | $421K |
| Other | SYMETRA LIFE INSURANCE CO. | 1,535 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,621 | — |
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.
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.