| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | $42K | $46K | 3.14% |
| BCI GROUP, INC.3 Filed as: BCI GROUP | 6979 SE LAKE ROAD PORTLAND, OR 97267 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $11K | 19.18% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 WEST ERIE STREET SUITE 300 CHICAGO, IL 60654 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $893 | $0 | $893 | 1.50% |
| ANDREW N LUCCOCK3 | 22680 SW JAQUITH ROAD NEWBERG, OR 97132 | AFLAC | $3K | $22 | $3K | 9.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 2329 LAKE OSWEGO, OR 97035 | AFLAC | $923 | $0 | $923 | 2.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 6443 SW BEAVERTON HILLSDALE HIGHWAY SUITE 200 PORTLAND, OR 97221 | AFLAC | $413 | $0 | $413 | 1.31% |
| TYLER JACOB JORAMO3 | 3101 PERIWINKLE STREET FOREST GROVE, OR 97116 | AFLAC | $245 | $5 | $250 | 0.79% |
| BRYAN G CORBIN LLC3 | 18625 PILKINGTON ROAD LAKE OSWEGO, OR 97035 | AFLAC | $199 | $0 | $199 | 0.63% |
| TJ INSURANCE LLC3 | 3101 PERIWINKLE STREET FOREST GROVE, OR 97116 | AFLAC | $59 | $0 | $59 | 0.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | UNKNOWN SHERWOOD, OR 97140 | WILLAMETTE DENTAL INSURANCE, INC. | $504 | $0 | $504 | 5.00% |
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 | 149 | 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) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 175 | $1.5M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 175 | $1.5M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 175 | $1.5M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 155 | $60K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 155 | $60K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 155 | $60K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 175 | $1.5M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 155 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.