| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PKWY STE 100 PORTLAND, OR 97035 | PROVIDENCE HEALTH PLAN | $13K | — | $13K | 3.00% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PKWY STE 100 PORTLAND, OR 97035 | WILLAMETTE DENTAL INSURANCE, INC. | $901 | — | $901 | 5.59% |
| PCF INSURANCE SERVICES OF THE WEST3 | 7150 SW HAMPTON ST STE 140 PORTLAND, OR 97223 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $502 | $2K | 12.82% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: NATIONAL PCF BONUS ONLY | 2500 W EXECUTIVE PKWY STE 200 LEHI, UT 84043 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $186 | $186 | 1.46% |
| REVOLUTION BENEFITS GROUP, LLC3 Filed as: REVOLUTION BENEFITS GROUP LLC | 1867 WILLIAMS HIGHWAY STE 204 GRANTS PASS, OR 97527 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | — | $3K | 73.21% |
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 | 234 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 234 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 85 | $448K |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL INSURANCE, INC. | 26 | $29K |
| Life insurance | TRANSAMERICA LIFE INSURANCE COMPANY | 27 | $4K |
| Other | WELLFLEET INSURANCE COMPANY | 34 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 85 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.