| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NW 114TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $4K | 7.47% |
| AKT BENEFIT ADVISORS LP3 | 680 HAWTHORNE AVENUE SE SALEM, OR 97301 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 3.20% |
| SUSAN J LEACH3 | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $46 | $2K | 3.17% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $143 | $1K | 2.46% |
| PROPEL INSURANCE AGENCY LLC3 | DBA PROPEL INSURANCE TACOMA, WA 98402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $471 | — | $471 | 0.97% |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $280 | $2 | $282 | 0.58% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 0.19% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVENUE HILLSBORO, OR 97127 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $18 | $86 | 0.18% |
| BENJAMIN MOSQUEDA3 | 2855 CROCKERY SHORES RD CASNOVIA, MI 49318 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.08% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION STREET NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 9.31% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION STREET NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 6.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CU BENEFITS ALLIANCE BROKER | Insurance agents and brokers Service code 22 | — | $79K |
| EBMS EIN 81-0391256 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $67K |
| AETNA SIGNATURE ADMINISTRATORS EIN 06-6033492 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $37K |
| BENEFITS PARTNER LLC EIN 20-2024076 BROKER | Claims processing; Contract Administrator Service code 12 | — | $20K |
| NAVITUS HEALTH SOLUTIONS CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $10K |
| NAVIA BENEFITS EIN 91-1467758 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $9K |
| COFINITY EIN 20-1274723 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $3K |
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 | 218 | 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) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 218 | $91K |
| Long-term disability | STANDARD INSURANCE COMPANY | 218 | $46K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 51 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 218 | — |
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.