| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGER W. DAY3 | 8305 SE MONTEREY AVE. #212 HAPPY VALLEY, OR 97086 | HEALTH NET | $2K | — | $2K | 0.11% |
| OREGON AUTOMOTIVE TRADES ASSOC3 Filed as: OREGON AUTOMOTIVE TRADES ASSOCIATIO | 7931 NE HALSEY ST #212 PORTLAND, OR 97213 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | — | $1K | 0.34% |
| DIMARTINO ASSOCIATES3 | 1501 4TH AVE. STE. 2400 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $450 | — | $450 | 0.11% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WASHINGTON INC | 1501 4TH AVE. STE. 2400 SEATTLE, WA 98101 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $48 | — | $48 | 0.03% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WASHINGTON, INC | 1501 4TH AVE. STE. 2400 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $452 | — | $452 | 0.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OREGON AUTOMOTIVE TRADES ASSOC EIN 93-0889164 NONE | Direct payment from the plan; Other services Service code 49 | — | $79K |
| BROWN AND BROWN OF WASHINGTON, INC EIN 91-0378940 NONE | Insurance services; Direct payment from the plan; Other commissions; Insurance agents and brokers Service code 22 | — | $64K |
| BENEFIT SOLUTIONS, INC. EIN 91-1603312 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator Service code 14 | — | $40K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $13K |
| HEALTH INSURANCE STRATEGIES, INC NONE | Direct payment from the plan; Insurance agents and brokers; Other commissions Service code 22 | 320 SW UPPER TERRACE DR., STE 101 BEND, OR 97702 | $6K |
| MCKENZIE, ROTHWELL, BARLOW & COUGHR EIN 91-0889948 NONE | Legal; Direct payment from the plan Service code 29 | — | $6K |
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 | 429 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 430 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 386 | $2.1M |
| Dental(3 contracts, 3 carriers) | HEALTH NET | 386 | $1.9M |
| Vision | HEALTH NET | 386 | $1.7M |
| Prescription drug | HEALTH NET | 386 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 386 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.