| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF OREGON LLC | 941 OAK STREET EUGENE, OR 97401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 0.60% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | 150 SAWGRASS DRIVE ROCHSETER, NY 14620 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.11% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCES LLC | 200 GALLERIA PKWY SE STE 1950 STE 1650 ATLANTA, GA 30339 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $947 | — | $947 | 0.90% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF OREGON LLC | 941 OAK STREET EUGENE, OR 97401 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $756 | — | $756 | 0.72% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NORTHWEST 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $808 | $2K | — |
| BRATRUD MIDDLETON INSURANCE BROKERS3 | DBA PROPEL INSURANCE TACOMA, WA 98402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $824 | — | $824 | — |
| BENEFITS BY DESIGN INC3 | 2101 NORTHEAST 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $148 | $34 | $182 | — |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF OREGON LLC | 941 OAK STREET EUGENE, OR 97401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $180 | — | $180 | — |
| MICHAEL LEROY ALLEY3 Filed as: MICHAEL LEROY ALLEN | 5285 MEADOWS ROAD #370 LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $50 | $73 | — |
| DONALD C SAVOY INC3 Filed as: DONALD TERRY GOTHAM | 3129 ECLIPSE DRIVE GREEN BAY, WI 54311 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | — | $54 | — |
| KAREN CLAY KUNKLER3 | 1709 NORTHWEST 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | — |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | — |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | — |
| CHRISTINE LYNN MORGESTER3 | 2137 NORTH Q STREET WASHOUGAL, WA 98671 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | — |
| HEARTSEASE LLC3 | 1521 NORTHEAST 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $2 | $8 | — |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I BUCHOLTZ | 12517-217TH AVENUE COURT EAST BONNEY LAKE, WA 98391 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | — |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 120 | $332K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $105K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $105K |
| Life insurance | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 22 | $0 |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 120 | $332K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 22 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.