| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMA, INC.3 | 1135 MOLLY LANE EUGENE, OR 97404 | PROVIDENCE HEALTH PLAN | $6K | — | $6K | 2.00% |
| IMA, INC.3 | PO BOX 29 SPRINGFIELD, OR 97477 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $638 | $3K | 5.85% |
| WATCHTOWER BENEFITS, LLC3 | 2734 NORTH MILDRED AVENUE, SUITE 3 CHICAGO, IL 60618 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.56% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, LLC | UNKNOWN EUGENE, OR 97402 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $57 | — | $57 | 0.10% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 11.86% |
| IMA, INC.3 | PO BOX 2992 WICHITA, KS 67201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $202 | $202 | 0.52% |
| K.P.D. INSURANCE, LLC3 | PO BOX 784 SPRINGFIELD, OR 97477 | VISION SERVICE PLAN | $772 | — | $772 | 6.97% |
| WATCHTOWER TECHNOLOGIES INC3 Filed as: WATCHTOWER TECHNOLOGIES, INC. | 306 WEST ERIE STREET, SUITE 300 CHICAGO, IL 60654 | VISION SERVICE PLAN | $11 | — | $11 | 0.10% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | WILLAMETTE DENTAL INSURANCE, INC. | $420 | — | $420 | 5.00% |
| RICHARD E. SYFERT3 | PO BOX 917 PLEASANT HILL, OR 97455 | AFLAC | $204 | $0 | $204 | 4.44% |
| BRADLEY R. SWANK3 | 452 ISLAND HOUSE PATH THE VILLAGES, FL 32163 | AFLAC | $204 | $0 | $204 | 4.44% |
| JEROMY E. CILLEY3 | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $67 | $0 | $67 | 1.46% |
| CHRISTINE L BREWSTER3 Filed as: CHRISTINE L. BREWSTER | 701 CEDAR STREET MCKINNEY, TX 75069 | AFLAC | $8 | $0 | $8 | 0.17% |
| GARY W WARE JR3 Filed as: GARY W. WARE JR. | 3103 MEADOWBROOK DRIVE CHAMPAIGN, IL 61822 | AFLAC | $1 | $0 | $1 | 0.02% |
| MARGARET BRYANT3 | 18014 BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $72 | $0 | $72 | 2.88% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 2.52% |
| MARY ESTHER TAYLOR3 | 3670 WESTWARD HO AVENUE EUGENE, OR 97401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $34 | $0 | $34 | 1.36% |
| ISAACSON INSURANCE AGENCY LLC3 Filed as: ISAACSON INSURANCE AGENCY, LLC | 1821 NW 23RD PIACE PORTLAND, OR 97210 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 1.04% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.80% |
| THOMAS TAYLOR3 Filed as: THOMAS MCKY TAYLOR | 3670 WESTWARD HO AVENUE EUGENE, OR 97401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.08% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | MEDICAL AIR SERVICES ASSOCIATION, INC | $57 | $0 | $57 | 5.00% |
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 | 102 | 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) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 101 | $316K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 61 | $68K |
| Vision | VISION SERVICE PLAN | 55 | $11K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $41K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 4 | $7K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $39K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 101 | $314K |
| Other(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.