| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN T HARRIS3 Filed as: JOHN HARRIS | CU BENEFITS ALLIANCE 451 DIVISION STREET NE SALEM, OR 97301 | PACIFICSOURCE HEALTH PLANS | $14K | $0 | $14K | 1.38% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | STANDARD INSURANCE COMPANY | $3K | $0 | $3K | 6.62% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | PO BOX 784 SPRINGFIELD, OR 97477 | WILLAMETTE DENTAL OF WASHINGTON, INC. | $397 | $0 | $397 | 3.00% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | CONTINENTAL AMERICAN INSURANCE COMPANY | $119 | $0 | $119 | 4.18% |
| CAROL ANN KENYON3 | 1641 CLEVELAND HILL ROAD ROSEBURG, OR 97470 | CONTINENTAL AMERICAN INSURANCE COMPANY | $92 | $0 | $92 | 3.23% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $92 | $0 | $92 | 3.23% |
| RICHARD E. SYFERT3 Filed as: RICHARD ERIC SYFERT | 86195 PANORAMA ROAD SPRINGFIELD, OR 97478 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | $0 | $19 | 0.67% |
| MJ INSURANCE3 Filed as: ROBIN D HUDSON & VARIOUS AGENTS | PO BOX 1124 ASTORIA, OR 97103 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | $0 | $19 | 0.67% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | $0 | $16 | 0.56% |
| NOAH BAILEY3 Filed as: NOAH KYLE BAILEY | 201 WEST MAIN STREET, SUITE 4A MEDFORD, OR 97501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | $0 | $10 | 0.35% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | PO BOX 784 SPRINGFIELD, OR 97477 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $204 | $0 | $204 | 15.03% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE, LLC | PO BOX 784 SPRINGFIELD, OR 97477 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $17 | $0 | $17 | 14.78% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 512 | $1.0M |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL OF WASHINGTON, INC. | 129 | $16K |
| Vision | PACIFICSOURCE HEALTH PLANS | 512 | $1.0M |
| Life insurance | STANDARD INSURANCE COMPANY | 318 | $46K |
| Short-term disability | STANDARD INSURANCE COMPANY | 318 | $46K |
| Long-term disability | STANDARD INSURANCE COMPANY | 318 | $46K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 512 | $1.0M |
| Other(5 contracts, 4 carriers) | STANDARD INSURANCE COMPANY | 318 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 512 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.