| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $40K | $2K | $42K | 2.16% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $9K | $0 | $9K | 5.36% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $11K | $0 | $11K | 10.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $15K | $0 | $15K | 58.03% |
| KYONG H. GOINS3 Filed as: KYONG HIU GOINS | 7711 27TH AVENUE SW SEATTLE, WA 98126 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 4.02% |
| JAMES S SARANTIS3 Filed as: JAMES STEPHEN SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | $0 | $11 | 0.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $949 | $0 | $949 | 4.59% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | $0 | $2K | $2K | 20.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 350 | $1.9M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 351 | $171K |
| Vision(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 350 | $2.0M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 184 | $110K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 184 | $110K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 184 | $110K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 350 | $1.9M |
| Other(3 contracts, 3 carriers) | LIFEMAP ASSURANCE COMPANY | 203 | $144K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 351 | — |
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.