| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | PROVIDENCE HEALTH PLAN | $16K | — | $16K | 1.82% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $13K | — | $13K | 1.84% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | METROPOLITAN LIFE INSURANCE COMPANY | $18K | — | $18K | 11.28% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $2K | — | $2K | 13.00% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $1K | — | $1K | 8.13% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $223 | — | $223 | 1.79% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $102 | — | $102 | 0.82% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $3K | — | $3K | 30.36% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $3K | — | $3K | 24.28% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $764 | — | $764 | 7.15% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $218 | — | $218 | 2.04% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $3K | — | $3K | 34.03% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $2K | — | $2K | 27.22% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $586 | — | $586 | 7.84% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $154 | — | $154 | 2.06% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $579 | — | $579 | 10.01% |
| WEALTH STRATEGIES NORTHWEST4 Filed as: WEALTH STRATGAGIES NW, LLC | 5100 SW MACADAM PORTLAND, OR 97239 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $12 | — | $12 | 0.21% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $1K | — | $1K | 33.27% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $869 | — | $869 | 26.60% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $252 | — | $252 | 7.71% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $69 | — | $69 | 2.11% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $622 | — | $622 | 29.45% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $498 | — | $498 | 23.58% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $145 | — | $145 | 6.87% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $43 | — | $43 | 2.04% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $537 | — | $537 | 34.76% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $430 | — | $430 | 27.83% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $123 | — | $123 | 7.96% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $32 | — | $32 | 2.07% |
| BENEFIT DESIGN GROUP INC3 Filed as: BENEFIT DESIGN GROUP, LLC | 7140 SW FIR LOOP 220 PORTLAND, OR 97223 | AMERICAN HERITAGE LIFE INSURANCE | $235 | — | $235 | 32.24% |
| CARR INSURANCE AGENCY LLC3 | PO BOX 4545 BEAVERTON, OR 97076 | AMERICAN HERITAGE LIFE INSURANCE | $188 | — | $188 | 25.79% |
| CHARLOTTE R SANTA CRUZ4 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE | $55 | — | $55 | 7.54% |
| SUPPLEMENTAL BENEFIT SOLUTIONS4 | PO BOX 1849 LAKE OSWEGO, OR 97035 | AMERICAN HERITAGE LIFE INSURANCE | $16 | — | $16 | 2.19% |
| PREMIER WORKSIDE SOLUTIONS INC4 | 806 NW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE | $8 | — | $8 | 1.17% |
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 | 182 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts, 3 carriers) | PROVIDENCE HEALTH PLAN | 181 | $1.6M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 393 | $158K |
| Vision | GUARDIAN LIFE INSURANCE CO OF AMERICA | 26 | $6K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 393 | $172K |
| Prescription drug(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 181 | $1.6M |
| Other(7 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 393 | $196K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 393 | — |
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.