| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CU BENEFITS ALLIANCE3 | PO BOX 12398 SALEM, OR 97309 | HM LIFE INSURANCE COMPANY | $27K | — | $27K | 10.00% |
| CU BENEFIT ALLIANCE3 | 451 DIVISION STREET NE SALEM, OR 97301 | WILLAMETTE DENTAL INSURANCE INC | $4K | — | $4K | 5.00% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION STREET NE SALEM, OR 97301 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 12.49% |
| CU BENEFITS ALLIANCE3 | 451 DIVISION STREET NE SALEM, OR 97301 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HM INSURANCE EIN 06-1041332 INSURER | Insurance services Service code 23 | — | $250K |
| HEALTHCARE MANAGEMENT ADMINISTRATOR EIN 91-1333840 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $71K |
| CU BENEFITS ALLIANCE EIN 61-1691027 BROKER | Other commissions; Insurance agents and brokers Service code 22 | — | $39K |
| AIG LIFE INSURANCE CO EIN 13-5459480 INSURER | Insurance services Service code 23 | — | $17K |
| VISION SERVICE PLAN EIN 06-1227840 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $6K |
| UNION SECURITY INSURANCE COMPANY EIN 81-0170040 CLAIMS PROCESSOR | Other fees; Claims processing Service code 12 | — | $5K |
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 | 168 | 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) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY | 175 | $293K |
| Dental | WILLAMETTE DENTAL INSURANCE INC | 155 | $71K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 233 | $20K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 233 | $20K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 218 | $28K |
| Prescription drug | HM LIFE INSURANCE COMPANY | 175 | $274K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 175 | $274K |
| Other | TOKIO MARINE HCC | 175 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.