| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NW | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $42K | $0 | $42K | 3.19% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $1K | $4K | 5.18% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 6.72% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $1K | $1K | 3.14% |
| MICHAEL W. ATTERBERRY3 Filed as: MICHAEL J. KUVAAS | 2300 OAKMONT WAY, SUITE 203 EUGENE, OR 97401 | AFLAC | $1K | $159 | $1K | 7.62% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $237 | $0 | $237 | 1.23% |
| MJ INSURANCE3 Filed as: SCOTT NIELSEN AND VARIOUS AGENTS | 718B WEST FOURTH PLAIN BOULEVARD VANCOUVER, WA 98660 | AFLAC | $199 | $0 | $199 | 1.03% |
| JOHNNY WAYNE ROBBINS3 | 29744 AWBREY LANE, UNIT B EUGENE, OR 97402 | AFLAC | $112 | $37 | $149 | 0.77% |
| JEROMY E. CILLEY3 | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $131 | $0 | $131 | 0.68% |
| RICHARD E. SYFERT3 | PO BOX 917 PLEASANT HILL, OR 97455 | AFLAC | $62 | $37 | $99 | 0.51% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $80 | $0 | $80 | 0.42% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $912 | $0 | $912 | 6.33% |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 208 | $1.3M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 311 | $99K |
| Vision | VISION SERVICE PLAN | 104 | $14K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 113 | $57K |
| Short-term disability | AFLAC | 16 | $19K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 208 | $1.3M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 113 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 311 | — |
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.