| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | PROVIDENCE HEALTH PLAN | $40K | $0 | $40K | 2.70% |
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | HARTFORD LIFE AND ACCIDENT | $14K | $0 | $14K | 15.00% |
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | WILLAMETTE DENTAL INSURANCE, INC | $2K | $0 | $2K | 5.00% |
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $603 | $0 | $603 | 1.94% |
| NICHOLS, DALE, ALLEN3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $197 | $0 | $197 | 0.63% |
| LEONARD ADAMS INSURANCE INC3 | 5201 SW WESTGATE DR STE 300 PORTLAND, OR 97221 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | $0 | $90 | 0.29% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $13 | $13 | 0.04% |
| BENEFIT COMMUNICATIONS INC3 | 2977 SIDCO DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.03% |
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 | 172 | 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) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 165 | $1.5M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC | 47 | $47K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 209 | $90K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 209 | $90K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 209 | $90K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 209 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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.