| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 29 SPRINGFIELD, OR 97477 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $14K | $14K | 1.53% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 29 SPRINGFIELD, OR 97477 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 7.50% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 29 SPRINGFIELD, OR 97477 | WILLAMETTE DENTAL INSURANCE, INC. | $1K | $0 | $1K | 5.00% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 784 SPRINGFIELD, OR 97477 | VISION SERVICE PLAN | $833 | $0 | $833 | 6.75% |
| BRADLEY R. SWANK3 Filed as: BRADLEY SWANK | PO BOX 872 SPRINGFIELD, OR 97477 | AFLAC | $244 | $0 | $244 | 7.96% |
| RICHARD E. SYFERT3 Filed as: RICHARD SYFERT | 86195 PANORAMA ROAD SPRINGFIELD, OR 97478 | AFLAC | $244 | $0 | $244 | 7.96% |
| MJ INSURANCE3 Filed as: RICHARD SUMMERS AND VARIOUS AGENTS | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | AFLAC | $78 | $0 | $78 | 2.54% |
| CLIFF HARRISON BARROWS3 Filed as: CLIFF BARROWS | 5716 SOUTH FARRALL STREET SPOKANE, WA 99223 | AFLAC | $62 | $0 | $62 | 2.02% |
| JEROMY E. CILLEY3 Filed as: JEROMY CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | AFLAC | $59 | $0 | $59 | 1.92% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | AFLAC | $39 | $0 | $39 | 1.27% |
| MARY TAYLOR3 | 1720 TABOR STREET EUGENE, OR 97401 | AFLAC | $24 | $0 | $24 | 0.78% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $106 | $17 | $123 | 6.94% |
| MARY TAYLOR3 Filed as: MARY ESTER TAYLOR | PO BOX 70334 SPRINGFIELD, OR 97475 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $96 | $17 | $113 | 6.38% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $64 | $48 | $112 | 6.32% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 29 SPRINGFIELD, OR 97477 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $107 | $0 | $107 | 6.04% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $35 | $66 | 3.72% |
| DAMON RAY OGIER3 | 540 SW FOUNDRY STREET GRANTS PASS, OR 97526 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.79% |
| MJ INSURANCE3 Filed as: EDWARD ESTRADA AND VARIOUS AGENTS | 580 PATRICK LOOP COTTAGE GROVE, OR 97424 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $6 | $12 | 0.68% |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 100 | $895K |
| Dental(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 112 | $124K |
| Vision | VISION SERVICE PLAN | 68 | $12K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 112 | $100K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 6 | $5K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 112 | $98K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 100 | $895K |
| Other(4 contracts, 4 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 120 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.