| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 97333 | QBE INSURANCE CORPORATION | $49K | — | $49K | 5.66% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | PO BOX 1185 CORVALLIS, OR 97339 | WILLAMETTE DENTAL INSURANCE INC | $6K | — | $6K | 5.00% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 973334551 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 4.15% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 97333 | VISION SERVICE PLAN | $2K | — | $2K | 2.94% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 97333 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 10.48% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 97333 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 7.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Float revenue; Other fees; Claims processing Service code 12 | 2300 MAIN STREET IRVINE, CA 92614 | $892K |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 1087 WAUSAU, WI 544021087 | $318K |
| TIMOTHY HENNESSY EIN 55-9760447 BROKER | Other commissions Service code 55 | 226 SW 7TH STREET CORVALLIS, OR 97333 | $47K |
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 | 640 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 640 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | WILLAMETTE DENTAL INSURANCE INC | 299 | $117K |
| Vision | VISION SERVICE PLAN | 602 | $77K |
| Life insurance | STANDARD INSURANCE COMPANY | 640 | $93K |
| Short-term disability | STANDARD INSURANCE COMPANY | 178 | $32K |
| Long-term disability | STANDARD INSURANCE COMPANY | 178 | $36K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE CORPORATION | 0 | $867K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 640 | — |
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.