| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | UNKNOWN THE DALLES, OR 97058 | MODA HEALTH | $14K | $0 | $14K | 0.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | UNKNOWN BOTHELL, WA 98011 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 17.34% |
| HEARTSEASE LLC3 | 1521 NORTHEAST 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $3K | $8K | 11.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 8.68% |
| WORKSITE BENEFITS GROUP INC3 | 112 NORTHWEST 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $3K | $5K | 6.51% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH STREET WEST LINN, OR 97068 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $988 | $5K | 6.39% |
| BENEFITS BY DESIGN INC3 | 2101 NORTHEAST 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $692 | $2K | 3.07% |
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 | 106 | 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) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA HEALTH | 214 | $1.7M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 234 | $121K |
| Vision | MODA HEALTH | 214 | $1.7M |
| Life insurance | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 104 | $78K |
| Short-term disability | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 104 | $78K |
| Long-term disability | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 104 | $78K |
| Prescription drug | MODA HEALTH | 214 | $1.7M |
| Other(2 contracts, 2 carriers) | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 104 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 234 | — |
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.