| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERMEDIARY SERVICES LLC3 | 333 SOUTH STATE STREET SUITE VMPB 283 LAKE OSWEGO, OR 97035 | QBE INSURANCE | $2K | — | $2K | 1.02% |
| INTERMEDIARY SERVICES LLC3 Filed as: INTERMEDIARY SERVICES, LLC | 333 SOUTH STATE STREET SUITE #VPMB 283 LAKE OSWEGO, OR 97035 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 6.23% |
| INTERMEDIARY SERVICES LLC3 Filed as: INTERMEDIARY SERVICES, LLC | 333 SOUTH STATE STREET SUITE #VPMB 283 LAKE OSWEGO, OR 97035 | SUN LIFE ASSURANCE COMPANY OF CANADA | $816 | — | $816 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMIN | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $55K |
| CIGNA EIN 59-1031071 PPO/UR VENDOR | Direct payment from the plan; Other fees Service code 50 | — | $27K |
| INTERMEDIARY SERVICES EIN 93-1323288 BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $15K |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 154 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 170 | $43K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 17 | $5K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 160 | $179K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 170 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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."
No prospect flags tripped on this filing.