| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS C. NEWTON3 | PO BOX 785 LAKE OSWEGO, OR 97034 | PACIFICSOURCE HEALTH PLANS | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS EIN 39-1997579 NONE | Plan Administrator; Claims processing Service code 12 | 5560 WEST GRANDE MARKET DR APPLETON, WI 54913 | $117K |
| KKC SERVICES, INC. EIN 93-1280442 NONE | Consulting (general) Service code 16 | 6004 NE ALAMEDA ST PORTLAND, OR 97213 | $45K |
| BULLARD LAW PC EIN 93-0693273 NONE | Legal Service code 29 | 200 SW MARKET ST SUITE 1900 PORTLAND, OR 97201 | $35K |
| KERN & THOMPSON, LLC EIN 93-1157146 NONE | Accounting (including auditing) Service code 10 | 1800 SW FIRST AVENUE SUITE 410 PORTLAND, OR 97201 | $18K |
| B&B PRINT SOURCE EIN 93-0962705 NONE | Copying and duplicating Service code 36 | 9040 SW BURNHAM ST TIGARD, OR 97223 | $7K |
| CHUBB GROUP OF INSURANCE COMPANIES EIN 13-1963496 NONE | Insurance agents and brokers Service code 22 | 15 MOUNTAIN VIEW RD WARREN, NJ 07059 | $0 |
| CIGNA EIN 59-1031071 NONE | Claims processing Service code 12 | PO BOX 645014 CINCINNATI, OH 452645014 | $0 |
| MILLIMAN EIN 91-0675641 NONE | Actuarial Service code 11 | 1301 FIFTH AVE SUITE 3800 SEATTLE, WA 97101 | $0 |
| PRO HEALTH ADVISORS EIN 91-1915938 NONE | Finders' fees / placement fees Service code 61 | 300 WEST 8TH STREET UNIT 205 VANCOUVER, WA 98660 | $0 |
| TOM NEWTON NONE | Consulting (general) Service code 16 | 642 EVERGREEN ROAD LAKE OSWEGO, OR 97034 | $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 | 1,004 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,004 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 1,004 | $8.5M |
| Dental | PACIFICSOURCE HEALTH PLANS | 1,004 | $8.5M |
| Vision | PACIFICSOURCE HEALTH PLANS | 1,004 | $8.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,004 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.