| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST, LLC | PO BOX 10167 EUGENE, OR 97440 | PACIFICSOURCE HEALTH PLANS | $27K | $0 | $27K | 1.16% |
| JOHNSON BENEFIT GROUP, INC.3 | 1750 BLANKENSHIP ROAD, SUITE 125 WEST LINN, OR 97068 | PACIFICSOURCE HEALTH PLANS | $25K | $0 | $25K | 1.10% |
| CASCADE EAST BENEFITS, INC.3 | 550 NW FRANKLIN AVENUE, SUITE 378 BEND, OR 97703 | PACIFICSOURCE HEALTH PLANS | $23K | $0 | $23K | 0.98% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PACIFICSOURCE HEALTH PLANS | $13K | $0 | $13K | 0.59% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | PACIFICSOURCE HEALTH PLANS | $1K | $0 | $1K | 0.06% |
| OREGON INSURANCE COMPANY3 | PO BOX 867 CRESWELL, OR 97426 | PACIFICSOURCE HEALTH PLANS | $856 | $0 | $856 | 0.04% |
| GOSSARD AND ASSOCIATES, INC.3 | PO BOX 1145 CRESCENT LAKE, OR 97733 | PACIFICSOURCE HEALTH PLANS | $811 | $0 | $811 | 0.04% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | PACIFICSOURCE HEALTH PLANS | $0 | $255 | $255 | 0.01% |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 271 | $2.3M |
| Dental | PACIFICSOURCE HEALTH PLANS | 271 | $2.3M |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 271 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.