| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | PACIFICSOURCE HEALTH PLANS | $13K | $0 | $13K | 1.72% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 4.21% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | WILLAMETTE DENTAL INSURANCE INC | $571 | $0 | $571 | 3.00% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | CONTINENTAL AMERICAN INSURANCE COMPANY | $414 | $0 | $414 | 4.51% |
| MARCI MARIE OTIS3 Filed as: MARCI OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $242 | $0 | $242 | 2.64% |
| CAROL A. KENYON3 Filed as: CAROL KENYON | 1641 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $140 | $0 | $140 | 1.53% |
| MJ INSURANCE3 Filed as: RAYMON KEECH AND VARIOUS AGENTS | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | CONTINENTAL AMERICAN INSURANCE COMPANY | $88 | $0 | $88 | 0.96% |
| JAMES S SARANTIS3 Filed as: JAMES SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $48 | $0 | $48 | 0.52% |
| JEROME E. CILLEY3 Filed as: JEROME CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $44 | $0 | $44 | 0.48% |
| MJ INSURANCE3 Filed as: ROBIN HUDSON | PO BOX 298 BENECIA, CA 94510 | CONTINENTAL AMERICAN INSURANCE COMPANY | $35 | $0 | $35 | 0.38% |
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 | 304 | 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) | 304 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 463 | $772K |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL INSURANCE INC | 128 | $28K |
| Vision | PACIFICSOURCE HEALTH PLANS | 463 | $772K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 304 | $41K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 304 | $41K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 304 | $41K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 463 | $772K |
| Other(4 contracts, 4 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 304 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.