| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BCI GROUP, INC.3 | 6979 SE LAKE ROAD PORTLAND, OR 97267 | PROVIDENCE HEALTH PLAN | $54K | — | $54K | 1.83% |
| BCI GROUP, INC.3 | 6979 SE LAKE ROAD PORTLAND, OR 97267 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $15K | — | $15K | 4.95% |
| BCI GROUP, INC.3 | 307 OAK STREET HOOD RIVER, OR 97031 | UNION SECURITY INSURANCE COMPANY | $14K | — | $14K | 10.97% |
| BCI GROUP, INC.3 | 307 OAK STREET HOOD RIVER, OR 97031 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 7.96% |
| ZARA ANNE PINES3 | 7224 SW 28TH AVENUE PORTLAND, OR 97219 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $796 | $3K | 2.29% |
| MJ INSURANCE3 Filed as: SUSAN J. LEACH AND VARIOUS AGENTS | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $87 | $2K | 1.61% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 806 NW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $395 | $2K | 1.39% |
| PATRICK IAN WAGNER3 | 4580 PEBBLE BROOK LANE PLANO, TX 75093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.34% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $211 | $1K | 1.33% |
| DARL CORNMAN3 | 18399 SW 133RD TERRACE TUALATIN, OR 97062 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $630 | $39 | $669 | 0.60% |
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 | 396 | 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) | 396 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 754 | $3.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 340 | $301K |
| Life insurance | UNION SECURITY INSURANCE COMPANY | 396 | $128K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 157 | $112K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 396 | $128K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 754 | $3.0M |
| Other(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 754 | $3.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 754 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.