| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | — | $13K | 4.65% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES INC | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $993 | — | $993 | 0.35% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 6.30% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES INC | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $514 | — | $514 | 0.75% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 8.21% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $381 | — | $381 | 0.84% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $459 | — | $459 | 6.38% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $261 | — | $261 | 3.63% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $483 | $979 | $1K | 39.75% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD TIGARD, OR 97224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $613 | $289 | $902 | 24.52% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | $208 | $360 | 9.79% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | $107 | $254 | 6.91% |
| CASSANDRA KRAMER3 | 640 E PIONEER LOOP LA CENTER, WA 98629 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $3 | $89 | 2.42% |
| ALEXANDER OTTONIEL CANAS3 | 26123 BOUQUET CANYON RD SANTA CLARITA, CA 91350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $6 | $29 | 0.79% |
| PATRICIA BLANCO ESPARZA3 | 4309 BRADLEY LANE ARLINGTON, TX 76017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.71% |
| BROCKSTAR LLC3 | 2561 FALCON RIDGE DRIVE GRAYSON, GA 30017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $1 | $19 | 0.52% |
| MPART BENEFITS INC3 | 4621 GLEN HEATHER DRIVE FRIXCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $6 | $10 | 0.27% |
| JOHN D EVANGELISTA3 | 26111 ANTONIA PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $2 | $6 | 0.16% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $2 | $5 | 0.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF ORE EIN 93-0238155 CONTRACT ADMINISTRATOR | Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $1.2M |
| CIGNA EIN 06-1059331 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $40K |
| EXPRESS SCRIPTS INC EIN 43-1420563 PRESCRIPTION ADMIN | Contract Administrator; Claims processing Service code 12 | — | $30K |
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 | 2,280 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 619 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 95 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,994 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 4,734 | $2.3M |
| Vision | EYEMED | 3,805 | $131K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,890 | $374K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 35 | $11K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 469 | $174K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 4,734 | $2.3M |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,890 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,734 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.