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Form 5500 · Employee benefit plan · MILWAUKIE, OR

CONVERGENCE NETWORKS, INC.

The filing calls this plan CONVERGENCE NETWORKS, INC. HEALTH AND WELFARE PLAN.

CONVERGENCE NETWORKS, INC. of MILWAUKIE, OR insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is WOODRUFF-SAWYER OREGON, INC. Coverage is written through REGENCE BLUECROSS BLUESHIELD OF OREGON and 1 other carrier. The plan's most recent policy period ended in March.

Benefits broker of record
Policy year ends
Marchas filed for plan year 2025

Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-1304921 · plan 501 · plan year 2025, filed Aug 18, 2025

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How this plan is funded

Fully insured as reported

The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.

All participants at the start of the year
136
Active at start of year
136
Active at end of year
114
Disclosed commissions
$84,962
Typical renewal
April 1

Benefits declared on this filing

Healthinsured — REGENCE BLUECROSS BLUESHIELD OF OREGON234 of 136 participants on the largest contract
Dentalinsured — PRINCIPAL LIFE INSURANCE COMPANY236 of 136 participants
Visioninsured — REGENCE BLUECROSS BLUESHIELD OF OREGON234 of 136 participants
Lifeinsured — PRINCIPAL LIFE INSURANCE COMPANY236 of 136 participants
Disabilityinsured — PRINCIPAL LIFE INSURANCE COMPANY236 of 136 participants

Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.

Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.

Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.

Plan brief

Schedule A lists 2 insured contracts covering health, dental, vision, life and disability; the largest, with REGENCE BLUECROSS BLUESHIELD OF OREGON, covers 234 people.

Reported premium across the insured contracts is $1,617,554, with $84,962 in disclosed broker commissions — about 5.3% of premium.

The most recent policy period ended in March, and the plan year ends March 31. Group contracts typically renew on that annual cycle.

WOODRUFF-SAWYER OREGON, INC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.

Two carriers split the book: REGENCE BLUECROSS BLUESHIELD OF OREGON and PRINCIPAL LIFE INSURANCE COMPANY.

Schedule A insurance contracts

CarrierBenefitsCoveredRenewsPremiumCommission
REGENCE BLUECROSS BLUESHIELD OF OREGONHealth, Vision234Apr 1, 2025$1,449,139$73,562
PRINCIPAL LIFE INSURANCE COMPANYHealth, Dental, Life, Disability236Apr 1, 2025$168,415$11,400

Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.

See the filing at the Department of Labor

Administrator and service providers

Plan administrator on the filing
CONVERGENCE NETWORKS, INC.
EIN 93-1304921

The plan administrator is from line 3a of the main form. We publish company names only.

Other plans filed by this employer

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