| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GCG FINANCIAL LLC3 Filed as: DAVIDSON BENEFITS AN ALERA AGENCY | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $3K | $6K | 7.10% |
| SUPPLEMENTAL BENEFIT SOLUTIONS3 Filed as: SUPPLEMENTAL BENEFIT SOLUTIONS INC | PO BOX 1849 TIGARD, OR 97223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 30.00% |
| SUPPLEMENTAL BENEFITS SERVICES INC Filed as: SUPPLEMENTAL BENEFIT | — | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| SUPPLEMENTAL BENEFIT SOLUTIONS3 Filed as: SUPPLEMENTAL BENEFIT SOLUTIONS INC | PO BOX 1849 TIGARD, OR 97223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 30.00% |
| SUPPLEMENTAL BENEFIT SOLUTIONS3 Filed as: SUPPLEMENTAL BENEFIT SOLUTIONS INC | PO BOX 1849 TIGARD, OR 97223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $389 | — | $389 | 11.03% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN RD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $43 | $43 | 1.22% |
| GCG FINANCIAL LLC3 Filed as: DAVIDSON BENEFITS AN ALERA AGENCY | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | RELIANCE STANDARD LIFE INSURANCE COMPANY | -$1 | — | -$1 | -0.03% |
| SUPPLEMENTAL BENEFIT SOLUTIONS3 Filed as: SUPPLEMENTAL BENEFIT SOLUTIONS INC | PO BOX 1849 TIGARD, OR 97223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $440 | — | $440 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUN LIFE ASSURANCE COMPANY OF CANAD EIN 38-1082080 NONE | Insurance services Service code 23 | — | $448K |
| HEALTHCARE MANAGEMENT ADMINISTRATOR EIN 91-1333840 NONE | Contract Administrator Service code 13 | — | $61K |
| DAVIDSON BENEFITS AN ALERA AGENCY EIN 93-1263635 NONE | Insurance agents and brokers Service code 22 | — | $43K |
| PACIFICSOURCE ADMINISTRATORS INC EIN 30-0140934 ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $2K |
| EXPRESS SCRIPTS INC EIN 43-1420563 ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $1K |
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 | 91 | 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) | 91 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 395 | $91K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 102 | $6K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 31 | $11K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 50 | $25K |
| Other | CASCADE CENTERS INC | 125 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.