| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 7.71% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 6.08% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $163 | $1K | 26.61% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $850 | $16 | $866 | 15.76% |
| AKT BENEFIT ADVISORS LP3 | 680 HAWTHORNE AVE SE SALEM, OR 97301 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $662 | — | $662 | 12.05% |
| PROPEL INSURANCE AGENCY LLC3 | 1201 PACIFIC AVENUE #1000 TACOMA, WA 98402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $389 | — | $389 | 7.08% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $268 | — | $268 | 4.88% |
| JUDY INEZ BUCHOLTZ3 | 12517 217TH AVENUE CT E BONNEY LAKE, WA 98391 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | $7 | $122 | 2.22% |
| ZINA OSTER3 | 3153 FOREST DR CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 1.51% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $3 | $62 | 1.13% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DR SE OLYMPIA, WA 98501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $10 | $27 | 0.49% |
| BENJAMIN MOSQUEDA3 | 2855 CROCKERY SHORES RD CASNOVIA, MI 49318 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.49% |
| SUSAN J LEACH3 | 4419 NE 131ST PLACE APT C1 PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.15% |
| MARGARET BRYANT3 | 18014 BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BERKLEY LIFE & HEALTH EIN 91-6034263 NONE | Insurance services Service code 23 | — | $447K |
| HEALTHCARE MANAGEMENT ADMINISTRATOR EIN 91-1333840 NONE | Contract Administrator Service code 13 | — | $136K |
| CU BENEFITS ALLIANCE EIN 61-1691027 NONE | Insurance agents and brokers Service code 22 | — | $94K |
| NAVIABENEFITS EIN 91-1467758 NONE | Claims processing Service code 12 | — | $9K |
| FIRST CHOICE HEALTH EIN 91-1272766 NONE | Contract Administrator Service code 13 | — | $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 | 240 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 253 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 244 | $47K |
| Long-term disability | STANDARD INSURANCE COMPANY | 244 | $60K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 44 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.