| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $74K | — | $74K | 11.79% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | WILLAMETTE DENTAL INSURANCE INC | $5K | — | $5K | 5.00% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION ST NE SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $250 | — | $250 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $214K |
| CU BENEFITS EIN 61-1691027 BROKER | Insurance agents and brokers Service code 22 | — | $74K |
| GUARDIAN LIFE INSURANCE CO EIN 13-5123390 CLAIMS PROCESSOR | Contract Administrator Service code 13 | — | $11K |
| UNITED OF OMAHA LIFE INSURANCE CO EIN 47-0322111 CLAIMS PROCESSOR | 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 | 266 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 278 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 320 | $631K |
| Dental | WILLAMETTE DENTAL INSURANCE INC | 199 | $98K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 320 | $631K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 280 | $31K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 280 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $45K |
| Other | CANOPY | 276 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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.