| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHANNON KIRK3 | PO BOX 29 SPRINGFIELD, OR 97477 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $0 | $406 | $406 | 0.01% |
| JACQUELINE DIEBERT3 | PO BOX 69508 PORTLAND, OR 97239 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $0 | $98 | $98 | 0.00% |
| DEBRA BRAILSFORD3 | PO BOX 29 SPRINGFIELD, OR 97477 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $0 | $70 | $70 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIS OF OREGON, INC. EIN 93-0569898 NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $234K |
| BENEFIT SOLUTIONS, INC. EIN 91-1603312 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $74K |
| STOEL RIVES EIN 93-0408771 NONE | Legal; Direct payment from the plan Service code 29 | — | $59K |
| DIGITAL INSURANCE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 200 GALLERIA PKWY #1950 ATLANTA, GA 30339 | $36K |
| KPD INSURANCE, INC NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | $18K |
| WARD INSURANCE AGENCY, INC. NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 560 COUNTRY CLUB PKWY. EUGENE, OR 97401 | $16K |
| BCI GROUP INC NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 307 OAK ST HOOD RIVER, OR 97031 | $15K |
| STRAUS & ASSOCIATES, INC. NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 100 E. MAIN STREET SUITE B MEDFORD, OR 97501 | $15K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $14K |
| BROWN & BROWN NORTHWEST INSURANCE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | FORMERLY FULLERTON AND COMPANY INC 2701 NW VAUGHN ST SUITE 340 PORTLAND, OR 97210 | $14K |
| MARTIN KNUTSEN & SON, INC. NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 968 COMMERCIAL ASTORIA, OR 97103 | $13K |
| JD FULWILER & COMPANY NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 5727 SW MACADAM AVE PORTLAND, OR 97239 | $11K |
| NORTHWEST BENEFIT STRATEGIES EIN 47-1615351 NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $11K |
| PROPEL INSURANCE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 888 SW 5TH AVE SUITE 1170 PORTLAND, OR 97204 | $9K |
| CASCADE SUMMIT INSURANCE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 1800 BLANKENSHIP RD #150 WEST LINN, OR 97068 | $8K |
| BARKER UERLINGS EIN 93-0475589 NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $8K |
| GOLSAN SCRUGGS INSURANCE INC. NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 10998 SW 68TH PARKWAY PORTLAND, OR 97223 | $8K |
| CRAVINHO & JAEGER FINANCIAL SERVICE NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 1495 LIBERTY ST SE SALEM, OR 97302 | $8K |
| OREGON COLUMBIA CHAPTER AGC EIN 23-7170147 PLAN SPONSOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $7K |
| AKT BENEFIT ADVISORS LP EIN 20-0407135 NONE | Direct payment from the plan Service code 50 | — | $5K |
| WHEATLAND FINANCIAL SERVICES, LLC NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 815 SW COURT AVE PENDLETON, OR 97801 | $5K |
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 | 750 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 755 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 750 | $7.7M |
| Dental | REGENCE BLUECROSS BLUESHIELD OF OREGON | 750 | $7.7M |
| Vision(4 contracts) | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 550 | $49K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 934 | $30K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 750 | $7.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 934 | — |
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 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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.