| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | UNKNOWN UKNOWN EUGENE, OR 97440 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $28K | — | $28K | 6.95% |
| CAMPBELL GALT AND NEWLANDS, INC.3 | PO BOX 3727 NORFOLK, VA 23514 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 4.85% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $510 | $4K | 11.46% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 10.80% |
| MJ INSURANCE3 Filed as: CORY MARK MUCHOW AND VARIOUS AGENTS | 416 HASKIN DRIVE PARDEEVILLE, WI 53954 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $360 | $3K | 9.20% |
| WELLS FARGO INSURANCE SERVICES3 | 1300 SW 5TH AVENUE PORTLAND, OR 97201 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 8.12% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $310 | $1K | 4.11% |
| DEREK THURSTON3 | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $896 | $40 | $936 | 2.82% |
| CARMEN L. BRENT3 | 1445 FOREST PLACE CALUMET CITY, IL 60409 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $834 | $83 | $917 | 2.76% |
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 | 183 | 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) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 209 | $400K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $90K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 209 | $400K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $90K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $90K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 209 | $400K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.