| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3018 BOTHELL, WA 98041 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $50K | $0 | $50K | 5.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3018 BOTHELL, WA 98041 | UNION SECURITY INSURANCE COMPANY | $4K | $0 | $4K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 15.23% |
| CORRY AGENCY, INC.3 Filed as: CORRY AGENCY INC | P O BOX 950 GIG HARBOR, WA 98335 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $60 | $5K | 10.27% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I BUCHOLTZ | 12517 217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $481 | $14 | $495 | 0.96% |
| NORTHWEST BENEFITS GROUP INC3 Filed as: NORTHWEST BENEFITS GROUP LLC | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $152 | $43 | $195 | 0.38% |
| NORTHEST BENEFITS GROUP LLC3 | 3104 MCALLISER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $152 | $43 | $195 | 0.38% |
| STEPHEN D PACE3 | 1016 GOLDENROD DRIVE NAMPA, ID 83686 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $128 | $0 | $128 | 0.25% |
| BRIAN WHITE3 Filed as: BRIAN RODERICK | 3104 MCALLISTER SREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $37 | $49 | 0.09% |
| BRIAN WHITE3 Filed as: BRIAN RODERICK | 3104 MCALLISTER STREET DUPONT, WA 98327 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $37 | $49 | 0.09% |
| GREGORY J. HINE3 Filed as: GREGORY J HINE | 8118 62ND DRIVE NORTHEAST MARYSVILLE, WA 98270 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NORTHEAST SUITE 1600 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3018 BOTHELL, WA 98041 | VISION SERVICE PLAN | $818 | $0 | $818 | 6.28% |
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 | 230 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 234 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 120 | $876K |
| Dental | UNION SECURITY INSURANCE COMPANY | 137 | $107K |
| Vision | VISION SERVICE PLAN | 101 | $13K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 231 | $88K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 231 | $88K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 120 | $876K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 231 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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.