| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK | 200 LIBERTY STREET NEW YORK, NY 10281 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 5.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET NEW YORK, NY 10281 | WILLAMETTE DENTAL INSURANCE, INC. | — | $11K | $11K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHEILD OF ORE EIN 93-0238155 CLAIMS PROCESSING | Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $317K |
| RXBENEFITS, INC. EIN 63-1157085 PHARMACY CONSULTANT | Other fees; Consulting fees Service code 70 | — | $6K |
| PACIFICSOURCE ADMINISTRATORS, INC EIN 30-0140934 FSA ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $3K |
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 | 541 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 550 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 1,154 | $786K |
| Dental(3 contracts, 3 carriers) | MODA HEALTH | 969 | $707K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 911 | $74K |
| Other | MHN SERVICES | 754 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,154 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.