| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RANDALL SKINNER3 | LEONARD ADAMS CO. 5201 SW WESTGATE DR., SUITE 300 PORTLAND, OR 97221 | PROVIDENCE HEALTH PLAN | $38K | $0 | $38K | 5.00% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE INC. | 5201 SW WESTGATE DR. STE 300 PORTLAND, OR 97221 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 15.26% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $0 | $1K | 10.64% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $853 | $0 | $853 | 7.90% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $0 | $151 | 1.40% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $121 | $0 | $121 | 1.12% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $0 | $87 | 0.81% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | PO 13090 PORTLAND, OR 97213 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $0 | $50 | 0.46% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.45% |
| LUIS EDUARDO CARDENAS3 | PO BOX 1983 ISSAQUAH, WA 98027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $0 | $45 | 0.42% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 5285 MEADOWS ROAD LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.29% |
| CHRISTINE LYNN MORGESTER3 | 9405 NE 100 WAY VANCOUVER, WA 98662 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.07% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE | 5201 SW WESTGATE DR. SUITE 300 PORTLAND, OR 97221 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $576 | $0 | $576 | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 6.08% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 5285 MEADOWS ROAD LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $2 | $15 | 3.65% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $2 | $10 | 2.43% |
| CHRISTINE LYNN MORGESTER3 | 7609 NE VANCOUVER MALL DR VANCOUVER, WA 98662 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $1 | $9 | 2.19% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 1.70% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 1.22% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OH 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 1.22% |
No Schedule C service providers reported on this filing.
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 | 267 | 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) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 193 | $755K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 145 | $44K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 267 | $17K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 27 | $13K |
| Other(4 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 267 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 267 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.