| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $19K | $2K | $21K | 9.75% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $904 | $257 | $1K | 5.12% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $705 | $87 | $792 | 3.49% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 806 NW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $256 | $123 | $379 | 1.67% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $367 | — | $367 | 1.62% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $260 | $97 | $357 | 1.57% |
| WELLS FARGO INSURANCE SERVICES3 | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $281 | — | $281 | 1.24% |
| MJ INSURANCE3 Filed as: ZINA OSTER AND VARIOUS AGENTS | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $209 | $18 | $227 | 1.00% |
| WELLS FARGO INSURANCE SERVICES3 | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | ZURICH AMERICAN INSURANCE COMPANY | $539 | — | $539 | 15.32% |
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 | 488 | 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) | 488 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 867 | $4.9M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 488 | $214K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 488 | $214K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 488 | $214K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 867 | $4.9M |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 488 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 867 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.