| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET 6TH FL SAN DIEGO, CA 92101 | WILLAMETTE DENTAL INSURANCE, INC. | — | $14K | $14K | 10.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET FL 6 SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $11K | — | $11K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFICSOURCE ADMINISTRATORS, INC EIN 30-0140934 FSA ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $0 |
| REGENCE BLUECROSS BLUESHEILD OF ORE EIN 93-0238155 CLAIMS PROCESSING | Claims processing; Direct payment from the plan; Float revenue Service code 12 | — | $0 |
| RXBENEFITS, INC. EIN 63-1157085 PHARMACY CONSULTANT | Other fees; Consulting fees Service code 70 | — | $0 |
| THE RAWLINGS GROUP NONE | Other fees Service code 99 | 1 EDEN PKWY LA GRANGE, KY 40031 | $0 |
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 | 754 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 754 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 1,262 | $1.0M |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL PLAN OF OREGON | 1,036 | $690K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 0 | $0 |
| Other(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 754 | $228K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,262 | — |
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.