| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PROVIDENCE HEALTH PLAN | $50K | $0 | $50K | 3.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 3.92% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $3K | $3K | 2.32% |
| MICHAEL W. ATTERBERRY3 Filed as: MICHAEL KUVAAS | 2300 OAKMONT WAY, SUITE 203 EUGENE, OR 97401 | AFLAC | $3K | $0 | $3K | 14.64% |
| RUSSELL JENSEN3 | 2452 NW HUMMINGBIRD DRIVE CORVALLIS, OR 97330 | AFLAC | $332 | $0 | $332 | 1.58% |
| MARCI MARIE OTIS3 Filed as: MARCI OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $244 | $0 | $244 | 1.16% |
| MJ INSURANCE3 Filed as: JOHNNY ROBBINS AND VARIOUS AGENTS | 2350 NORTH TERRY STREET, SPACE 105 EUGENE, OR 97402 | AFLAC | $233 | $0 | $233 | 1.11% |
| VINCENT BRIAN VOLLMAR3 Filed as: VINCENT VOLLMAR | 777 COMMERCIAL STREET SE, SUITE 20 SALEM, OR 97301 | AFLAC | $209 | $0 | $209 | 0.99% |
| JEROMY E. CILLEY3 Filed as: JEROMY CILLEY | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $101 | $0 | $101 | 0.48% |
| JAMES S SARANTIS3 Filed as: JAMES SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $75 | $0 | $75 | 0.36% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.85% |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 241 | $1.7M |
| Dental(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 137 | $157K |
| Vision | VISION SERVICE PLAN | 117 | $17K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 137 | $157K |
| Short-term disability | AFLAC | 15 | $21K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 241 | $1.7M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 137 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.