| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED FISCHER3 Filed as: FRED FISCHER, CFP, INC. | P.O. BOX 12888 SALEM, OR 97309 | PROVIDENCE HEALTH PLANS | $14K | $0 | $14K | 2.78% |
| CFP, INC.3 | P.O. BOX 12888 SALEM, OR 97309 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $0 | $1K | 3.88% |
| CFP, INC.3 | P.O. BOX 12888 SALEM, OR 97309 | SUN LIFE ASSURANCE COMPANY OF CANADA | $983 | $0 | $983 | 3.14% |
| CFP, INC.3 | P.O. BOX 12888 SALEM, OR 97309 | SUN LIFE ASSURANCE COMPANY OF CANADA | $929 | $0 | $929 | 2.97% |
| CFP, INC.3 | 625 HAWTHORNE AVE. SUITE 100 SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $401 | $0 | $401 | 3.64% |
| CFP, INC.3 | 625 HAWTHORNE AVE SUITE 100 SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $318 | $0 | $318 | 2.89% |
| CFP, INC.3 | 625 HAWTHORNE AVE SUITE 100 SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $239 | $0 | $239 | 2.17% |
| CFP, INC.3 | 625 HAWTHORNE AVE. SUITE 100 SALEM, OR 97301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $143 | $0 | $143 | 1.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| POLESTAR BENEFITS, INC. EIN 20-2371430 NONE | Contract Administrator; Direct payment from the plan Service code 13 | 412 JEFFERSON PKWY. #202 LAKE OSWEGO, OR 97035 | $6K |
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 | 128 | 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) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLANS | 122 | $512K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $42K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $42K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $42K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.