| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 7.30% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 5.27% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $945 | $138 | $1K | 2.63% |
| SUSAN J LEACH3 | 4419 NE 131ST PL APT C1 PORTLAND, OR 97230 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $483 | $3 | $486 | 1.18% |
| PROPEL INSURANCE AGENCY LLC3 | DBA PROPEL INSURANCE TACOMA, WA 98402 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $290 | — | $290 | 0.70% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $192 | — | $192 | 0.47% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $61 | $13 | $74 | 0.18% |
| ZINA OSTER3 | 3153 FOREST DR CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $64 | — | $64 | 0.16% |
| JUDY INEZ BUCHOLTZ3 | 12517 217TH AVENUE CT E BONNEY LAKE, WA 98391 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $7 | — | $7 | 0.02% |
| MARY BRYANT3 | 18014 BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE CO | $3 | — | $3 | 0.01% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | FIRST CHOICE HEALTH NETWORK | $446 | — | $446 | 6.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BERKLEY LIFE AND HEALTH EIN 91-6034263 NONE | Insurance services Service code 23 | — | $473K |
| HEALTH MANAGEMENT ADMINISTRATORS EIN 91-1333840 NONE | Contract Administrator Service code 13 | — | $150K |
| CU BENEFITS ALLIANCE EIN 61-1691027 NONE | Insurance agents and brokers Service code 22 | — | $86K |
| NAVIA BENEFIT SOLUTIONS INC EIN 91-1467758 NONE | Claims processing Service code 12 | — | $9K |
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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | STANDARD INSURANCE COMPANY | 245 | $53K |
| Long-term disability | STANDARD INSURANCE COMPANY | 245 | $64K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE CO | 248 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 248 | — |
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.