| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $0 | $9 | $9 | 0.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $0 | $12K | 5.29% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD STREET HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $5K | $10K | 6.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $0 | $5K | 3.00% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 1.76% |
| ROXANA BUSCHMAN3 Filed as: ROXANA BUSCHMAN AND OTHER AGENTS | 400 NE 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $174 | $3K | 1.56% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $625 | $3K | 1.55% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $203 | $2K | 1.26% |
| DARL CORNMAN3 | PO BOX 831 CANYONVILLE, OR 97417 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $507 | $0 | $507 | 0.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | ZURICH AMERICAN INSURANCE COMPANY | $470 | $0 | $470 | 15.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | $0 | $6 | 2.18% |
| MARK J ROBISON3 Filed as: MARK J. ROBISON | 1255 KIENAS ROAD KALISPELL, MT 59901 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 1.82% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.73% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.73% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD STREET HILLSBORO, OR 97124 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.36% |
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 | 344 | 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) | 344 | 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 | 809 | $4.1M |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 809 | $4.1M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $228K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $228K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $228K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 809 | $4.1M |
| Other(5 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $401K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 809 | — |
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.
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.