| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BCI GROUP, INC.3 Filed as: BCI GROUP | 6979 SOUTHEAST LAKE ROAD PORTLAND, OR 97267 | PROVIDENCE HEALTH PLANS | $54K | $0 | $54K | 1.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 6979 SOUTHEAST LAKE ROAD PORTLAND, OR 97267 | PROVIDENCE HEALTH PLANS | $11K | $0 | $11K | 0.34% |
| BCI GROUP, INC.3 | 6979 SOUTHEAST LAKE ROAD PORTLAND, OR 97267 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | $0 | $13K | 4.11% |
| BCI GROUP, INC.3 Filed as: BCI GROUP INC | 6979 SOUTHEAST LAKE ROAD PORTLAND, OR 97267 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $28K | $135 | $28K | 10.56% |
| BCI GROUP, INC.3 Filed as: BCI GROUP INC | 6979 SOUHEAST LAKE ROAD PORTLAND, OR 97267 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 1.53% |
| BCI GROUP, INC.3 Filed as: BCI GROUP INC | 307 OAK STREET HOOD RIVER, OR 97031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $712 | $0 | $712 | 6.86% |
| ZARA ANNE PINES3 | 7224 SOUTHWEST 28TH AVENUE PORTLAND, OR 97219 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $4 | $122 | 1.18% |
| PATRICK IAN WAGNER3 | 4580 PEBBLE BROOK LANE PLANO, TX 75093 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | $0 | $111 | 1.07% |
| BENEFITS BY DESIGN INC3 | 2101 NORTHEAST 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | $8 | $99 | 0.95% |
| MJ INSURANCE3 Filed as: DARL CORNMAN AND VARIOUS AGENTS | 18399 SOUTHWEST 133RD TERRACE TUALATIN, OR 97062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | $2 | $96 | 0.92% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NORTHEST 114TH STREET VANCOUVER, OR 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | $6 | $88 | 0.85% |
| SUSAN J LEACH3 | 4419 NORTHEAST 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $2 | $43 | 0.41% |
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 PLANS | 769 | $3.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 404 | $327K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 396 | $268K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 396 | $268K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 396 | $268K |
| Prescription drug | PROVIDENCE HEALTH PLANS | 769 | $3.3M |
| Other(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLANS | 769 | $3.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 769 | — |
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."
No prospect flags tripped on this filing.