| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WARD INSURANCE AGENCY INC3 Filed as: WARD INSURANCE AGENCY, INC. | PO BOX 10167 EUGENE, OR 97440 | PACIFICSOURCE HEALTH PLANS | $23K | $0 | $23K | 2.74% |
| CASCADE EAST BENEFITS, INC.3 | 550 NORTHWEST FRANKLIN AVENUE SUITE 378 BEND, OR 97703 | PACIFICSOURCE HEALTH PLANS | $8K | $0 | $8K | 0.91% |
| GOSSARD AND ASSOCIATES, INC.3 | PO BOX 506 MEDFORD, OR 97501 | PACIFICSOURCE HEALTH PLANS | $4K | $0 | $4K | 0.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | UNKNOWN SALEM, OR 97302 | WILLAMETTE DENTAL INSURANCE, INC. | $3K | $0 | $3K | 5.00% |
| WARD INSURANCE AGENCY INC3 Filed as: WARD INSURANCE AGENCY, INC. | PO BOX 10167 EUGENE, OR 97440 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 7.15% |
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 | 180 | 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) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 230 | $849K |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL INSURANCE, INC. | 146 | $89K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 146 | $39K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 230 | $849K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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."
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.