| 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 | $35K | $0 | $35K | 4.00% |
| 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% |
| GABRIEL ANGEL CANALS3 | 1329 NE 236TH AVE WOOD VILLAGE, OR 97060 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $334 | $2K | 8.02% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $732 | $465 | $1K | 6.38% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 5285 MEADOWS ROAD LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $765 | $131 | $896 | 4.78% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $434 | $425 | $859 | 4.58% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $710 | $0 | $710 | 3.79% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $469 | $210 | $679 | 3.62% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $384 | $135 | $519 | 2.77% |
| BRIAN STUBBS3 | 17960 SW SIOUX CT TUALATIN, OR 97062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $177 | $54 | $231 | 1.23% |
| CHRISTINE LYNN MORGESTER3 | 2137 N Q STREET WASHOUGAL, WA 98671 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $9 | $49 | 0.26% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | PO 13090 PORTLAND, OR 97213 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $0 | $45 | 0.24% |
| LUIS EDUARDO CARDENAS3 | PO BOX 1983 ISSAQUAH, WA 98027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.20% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE | 5201 SW WESTGATE DRIVE SUITE 300 PORTLAND, OR 97221 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 13.23% |
| 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 | 14.75% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $564 | $0 | $564 | 10.89% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE | 5201 SW WESTGATE DR. SUITE 300 PORTLAND, OR 97221 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $488 | $0 | $488 | 9.99% |
| GABRIEL ANGEL CANALS3 | 1329 NE 236TH AVE WOOD VILLAGE, OR 97060 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $11 | $51 | 9.26% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $14 | $35 | 6.35% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $13 | $26 | 4.72% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 5285 MEADOWS ROAD LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $4 | $25 | 4.54% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 4.17% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $6 | $19 | 3.45% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $4 | $15 | 2.72% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 203 | $887K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 151 | $44K |
| Life insurance(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 268 | $22K |
| Long-term disability(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 258 | $20K |
| Other(5 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 268 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 268 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.