| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | LIFEMAP ASSURANCE COMPANY | $11K | — | $11K | 5.28% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | PO BOX 29 SPRINGFIELD, OR 97477 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 5.84% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $398 | $24 | $422 | 2.45% |
| MJ INSURANCE3 Filed as: KAREN KUNKLER | 1709 NW 45TH AVE. CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $195 | $23 | $218 | 1.27% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 806 NW 79TH ST. VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $155 | $27 | $182 | 1.06% |
| LAPORTE & ASSOCIATES, INC3 Filed as: LAPORTE & ASSOC INC. | 5515 SE MILWAUKIE AVE. LAKE OSWEGO, OR 97202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $166 | — | $166 | 0.96% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST. MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $139 | $16 | $155 | 0.90% |
| VOLUNTARY BENEFITS SOL LLC3 Filed as: VOLUNTARY BENEFIT SOLUTIONS INC. | 12555 SW 1ST ST. BEAVERTON, OR 97005 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | — | $111 | 0.64% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH ST. RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $5 | $46 | 0.27% |
| RITA J ROBINSON3 Filed as: RITA ROBINSON | 21780 WILLAMETTE DR. WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.15% |
| ZINA OSTER3 | 3153 FOREST DR. CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.15% |
| CHRISTINE LYNN MORGESTER3 Filed as: CHRISTINE MORGESTER | 9405 NE 100TH WAY VANCOUVER, WA 98662 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.12% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST. VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.05% |
| PATRICK IAN WAGNER3 Filed as: PATRICK WAGNER | 4580 PEBBLEBROOK LN PLANO, TX 75093 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.04% |
| MARY TAYLOR3 | 1126 GATEWAY LOOP SPRINGFIELD, OR 97477 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.04% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE. HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $2 | $7 | 0.04% |
| SHEILAH RUND3 | 7395 OFFENHAUSER DR. RENO, NV 89511 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| DONALD GOTHAM3 | 3129 ECLIPSE DR. GREEN BAY, WI 54311 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF OR, LLC | 220 NW 2ND AVE. PORTLAND, OR 97209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | SYMETRA FINANCIAL | $898 | — | $898 | 10.61% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, INC. | 1111 GATEWAY LOOP SPRINGFIELD, OR 974771116 | SYMETRA FINANCIAL | $846 | — | $846 | 10.00% |
| JEFFREY SKREEN3 | 7265 SW MEADOWS CT. WILSONVILLE, OR 97070 | AFLAC | $39 | — | $39 | 3.56% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: ROBERT BROWN | 13190 SW PIMLICO TERR. BEAVERTON, OR 97008 | AFLAC | $28 | — | $28 | 2.55% |
| DAVID MARTIN GUSTAFSON3 Filed as: DAVID GUSTAFSON | 340 E. 41ST AVE. EUGENE, OR 97405 | AFLAC | $26 | — | $26 | 2.37% |
| BENEFIT CONSULTANTS INC3 Filed as: BENEFIT CONSULTANTS INC. | 307 OAK ST. HOOD RIVER, OR 97031 | AFLAC | $13 | — | $13 | 1.19% |
| JERRY OLIVER CREECH3 Filed as: JERRY CREECH | 233 MIDDLE ST. STE. 214 NEW BERN, NC 28560 | AFLAC | $8 | — | $8 | 0.73% |
| RITA J ROBINSON3 Filed as: RITA ROBINSON | 21780 WILLAMETTE DR. STE. B WEST LINN, OR 97068 | AFLAC | $5 | — | $5 | 0.46% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN. NE DUVALL, WA 98019 | AFLAC | $3 | — | $3 | 0.27% |
| CRAIG T RILEY3 Filed as: CRAIG RILEY | 6221 MONTANA LN. VANCOUVER, WA 98661 | AFLAC | $3 | — | $3 | 0.27% |
| SCOTT NIELSEN3 | 1089 LAKE WASHINGTON BLVD. N. APT. 306 RENTON, WA 98056 | AFLAC | $2 | — | $2 | 0.18% |
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 | 875 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 875 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 875 | $33K |
| Dental | LIFEMAP ASSURANCE COMPANY | 261 | $215K |
| Vision | LIFEMAP ASSURANCE COMPANY | 261 | $215K |
| Life insurance(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 261 | $233K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 21 | $17K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 261 | $215K |
| Prescription drug | SYMETRA FINANCIAL | 72 | $8K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 875 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 875 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.