| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEH HOLLOWAY3 | 5680 NW PONDOSA DR PORTLAND, OR 97229 | PROVIDENCE HEALTH PLANS | $10K | — | $10K | 1.11% |
| GCG FINANCIAL LLC3 Filed as: DAVIDSON BENEFIT AN ALERA AGENCY | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | PROVIDENCE HEALTH PLANS | $6K | — | $6K | 0.67% |
| ROBERT BESWICK/PREISZ ASSOC3 | 4525 SW CONDOR AVE PORTLAND, OR 97239 | PROVIDENCE HEALTH PLANS | $4K | — | $4K | 0.48% |
| JOSEPH HOLLOWAY3 | 5680 NW PONDOSA DR PORTLAND, OR 97229 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 4.30% |
| GCG FINANCIAL LLC3 Filed as: DDAVIDSON BENEFITS AN ALERA AGENCY | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH EQUITY INC CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $495 |
| PAYCOM INC EIN 80-0957485 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $47 |
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 | 104 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLANS | 151 | $861K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 152 | $118K |
| Vision | PROVIDENCE HEALTH PLANS | 151 | $861K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 152 | $118K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 152 | $118K |
| Prescription drug | PROVIDENCE HEALTH PLANS | 151 | $861K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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.