| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD. STE 115 TIGARD, OR 97224 | PACIFICSOURCE HEALTH PLANS | $22K | — | $22K | 3.02% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $2K | — | $2K | 15.00% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $1K | — | $1K | 10.00% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $1K | — | $1K | 15.00% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $550 | — | $550 | 14.99% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $441 | — | $441 | 15.02% |
| GCG FINANCIAL LLC3 Filed as: DAVDISON BENEFITS PLANNING LLC | 7632 SW DURHAM ROAD STE 115 TIGARD, OR 97224 | CIGNA GROUP INSURANCE | $107 | — | $107 | 10.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MODA HEALTH EIN 93-0438772 TPA | Contract Administrator; Other commissions Service code 13 | PO BOX 40384 PORTLAND, OR 972400384 | $3K |
| INFINISOURCE, INC EIN 38-2976613 CONTRACT ADMIN | Contract Administrator Service code 13 | 15 E WASHINGTON ST COLDWATER, MI 49036 | $2K |
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 | 141 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 214 | $735K |
| Life insurance | CIGNA GROUP INSURANCE | 176 | $13K |
| Short-term disability(2 contracts) | CIGNA GROUP INSURANCE | 54 | $20K |
| Long-term disability | CIGNA GROUP INSURANCE | 22 | $4K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 214 | $735K |
| Other(2 contracts) | CIGNA GROUP INSURANCE | 176 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 214 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.