| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR #300 PORTLAND, OR 97221 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $25K | — | $25K | 4.77% |
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR #300 PORTLAND, OR 97221 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $8K | — | $8K | 3.00% |
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR #300 PORTLAND, OR 97221 | GROUP HEALTH COOPERATIVE | $6K | — | $6K | 2.41% |
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR #300 PORTLAND, OR 97221 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | — | $5K | 4.93% |
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR #300 PORTLAND, OR 97221 | WILLAMETTE DENTAL INSURANCE, INC. | $2K | — | $2K | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan; Other services Service code 12 | — | $12K |
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 | 247 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 142 | $1.0M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 146 | $146K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 142 | $525K |
| Prescription drug(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 142 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.