| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF OREGON LLC | PO BOX 29018 PORTLAND, OR 97296 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $32K | $1K | $33K | 4.04% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF OREGON LLC | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $384 | $3K | 9.15% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $738 | $3K | 6.87% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP RD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $319 | $2K | 4.79% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $479 | $677 | $1K | 3.03% |
| BENEFITS BY DESIGNS INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $604 | $198 | $802 | 2.10% |
| GABRIEL ANGEL CANALS3 | 1549 NW CIVIC DR APT 204 GRESHAM, OR 97030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | $135 | $215 | 0.56% |
| JOEL SANDERS3 Filed as: JOEL SAMANDARI LUCAS | 2129 S BELAIR DR MOSES LAKE, WA 98837 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | $2 | $57 | 0.15% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH ST WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $9 | $42 | 0.11% |
| DAVID KINNEY3 | 802 NEVADA DR LONGVIEW, WA 98632 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $8 | $30 | 0.08% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.07% |
| SUSAN J LEACH3 | 4419 NE 131ST PL APT C1 PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $1 | $17 | 0.04% |
| TRICIA MILLER3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| ANGEL GABRIEL VELAZQUEZ-DIAZ3 | 2022 ESTANCIA CIR STE 6 KISSIMMEE, FL 34741 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| ZACHAREE KEITH SIAHPUSH3 | 6727 MLK JR WAY S STE M SEATTLE, WA 98118 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DR SE OLYMPIA, WA 98501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 10151 DEERWOOD PARK BLVD B100 STE 500 JACKSONVILLE, FL 32256 | USABLE LIFE | $805 | — | $805 | 9.10% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF OREGON LLC | PO BOX 29018 PORTLAND, OR 97296 | USABLE LIFE | $405 | $84 | $489 | 5.53% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 10151 DEERWOOD PARK BLVD B100 STE 500 JACKSONVILLE, FL 32256 | USABLE LIFE | $222 | — | $222 | 5.94% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF OREGON LLC | PO BOX 29018 PORTLAND, OR 97296 | USABLE LIFE | $121 | $31 | $152 | 4.07% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 10151 DEERWOOD PARK BLVD B100 STE 500 JACKSONVILLE, FL 32256 | USABLE LIFE | $67 | $26 | $93 | 8.87% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF OREGON LLC | PO BOX 29018 PORTLAND, OR 97296 | USABLE LIFE | $28 | $11 | $39 | 3.72% |
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 | 118 | 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) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 113 | $829K |
| Dental | REGENCE BLUECROSS BLUESHIELD OF OREGON | 113 | $829K |
| Vision | REGENCE BLUECROSS BLUESHIELD OF OREGON | 113 | $829K |
| Life insurance | USABLE LIFE | 118 | $4K |
| Short-term disability | USABLE LIFE | 6 | $1K |
| Long-term disability | USABLE LIFE | 118 | $9K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 118 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 118 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.