| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT LLC | 9340 SW BEAVERTON HILLSDALE HWY STE A BEAVERTON, OR 970053301 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 1.03% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT LLC | 1500 SW 1ST AVE PORTLAND, OR 972015815 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 0.80% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MGMT LLC | 9340 SW BVRTN HILLSDALE HWY STE A BEAVERTON, OR 97005 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MGMT LLC | 9340 SW BVRTN HILLSDALE HWY STE A BEAVERTON, OR 97005 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $73K |
| NIEDERMEYER RISK MANAGEMENT LLC BROKER | Other commissions Service code 55 | 1500 SW 1ST AVE STE A PORTLAND, OR 972015815 | $0 |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 181 | $248K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 181 | $248K |
| Life insurance | STANDARD INSURANCE COMPANY | 176 | $15K |
| Long-term disability | STANDARD INSURANCE COMPANY | 176 | $27K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 181 | $248K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.