| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE COMPANY | 5201 SW WESTGATE DRIVE, SUITE 300 PORTLAND, OR 97221 | PROVIDENCE HEALTH PLAN | $41K | $0 | $41K | 3.68% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE, INC. | 5201 SW WESTGATE DRIVE, SUITE 300 PORTLAND, OR 97221 | WILLAMETTE DENTAL INSURANCE, INC. | $5K | $0 | $5K | 7.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 700 NE MULTNOMAH STREET, SUITE 1300 PORTLAND, OR 97232 | WILLAMETTE DENTAL INSURANCE, INC. | $535 | $0 | $535 | 0.84% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE, INC. | 5201 SW WESTGATE DRIVE, SUITE 300 PORTLAND, OR 97221 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 12.99% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE, INC. | 5201 SW WESTAGE DRIVE, SUITE 300 PORTLAND, OR 97221 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 6.18% |
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 | 256 | 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) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 180 | $1.1M |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL INSURANCE, INC. | 139 | $82K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 256 | $42K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 256 | $24K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 180 | $1.1M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 256 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.