| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REVOLUTION BENEFITS GROUP, LLC3 Filed as: REVOLUTION BENEFITS GROUP LLC | — | ASSURITY LIFE INSURANCE COMPANY | $91K | — | $91K | 81.66% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PKWY STE 100 OSWEGO, OR 97035 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $2K | $7K | 9.13% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM, INC | 412 JEFFERSON PKWY STE 100 OSWEGO, OR 97035 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 1.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCF INSURANCE SERVICES EIN 82-1368960 | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $11K |
| STAR MARKETING AND ADMINISTRATION EIN 36-3403079 | Claims processing; Plan Administrator; Other services Service code 12 | — | $8K |
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 | 588 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 588 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ASSURITY LIFE INSURANCE COMPANY | 795 | $111K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $82K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 795 | — |
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.