| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER COMPANY INSURANCE | 5727 SW MACADAM PORTLAND, OR 97239 | PROVIDENCE HEALTH PLAN | $50K | $0 | $50K | 3.00% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER COMPANY INSURANCE | PO BOX 69508 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $15K | $546 | $15K | 2.86% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER COMPANY INSURANCE | 5727 SW MACADAM PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $403 | $8K | 8.93% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $412 | $0 | $412 | 0.45% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $137 | $0 | $137 | 0.15% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER COMPANY INSURANCE | 5727 SW MACADAM PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $977 | $0 | $977 | 2.27% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $584 | $4K | 18.51% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $162 | $4K | 16.56% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER COMPANY INSURANCE | 5727 SW MACADAM PORTLAND, OR 97239 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 7.90% |
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 | 415 | 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) | 415 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PROVIDENCE HEALTH PLAN | 310 | $2.3M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 438 | $91K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 79 | $22K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 438 | $91K |
| Prescription drug(3 contracts, 3 carriers) | PROVIDENCE HEALTH PLAN | 310 | $2.3M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 438 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 438 | — |
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."
No prospect flags tripped on this filing.