Form 5500 · Employee benefit plan · SHORELINE, WA
THE EVERGREEN SCHOOL
THE EVERGREEN SCHOOL of SHORELINE, WA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is SEA-MOUNTAIN INSURANCE BROKERS INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURNACE COMPANY and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-0756462 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURNACE COMPANY, covers 137 people.
Reported premium across the insured contracts is $453,713, with $64,625 in disclosed broker commissions — about 14% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
SEA-MOUNTAIN INSURANCE BROKERS INC. is the broker of record on all 5 contracts.
4 carriers appear on the filing — CIGNA HEALTH AND LIFE INSURNACE COMPANY, METROPOLITAN LIFE INSURANCE COMPANY, PRINCIPAL LIFE INSURANCE COMPANY and VISION SERVICE PLAN — with CIGNA HEALTH AND LIFE INSURNACE COMPANY writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURNACE COMPANY | Health | 137 | December | $290,145 | $52,485 |
| METROPOLITAN LIFE INSURANCE COMPANY | Dental | 177 | December | $91,904 | $4,586 |
| PRINCIPAL LIFE INSURANCE COMPANY | Life, Disability | 121 | December | $29,029 | $3,310 |
| PRINCIPAL LIFE INSURANCE COMPANY | Life, Disability | 121 | December | $29,029 | $3,310 |
| VISION SERVICE PLAN | Vision | 112 | December | $13,606 | $934 |
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