| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $0 | $2K | $2K | 0.05% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $0 | $13K | 4.85% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $2K | $7K | 5.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 3.16% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $282 | $3K | 2.16% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $627 | $2K | 1.55% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $294 | $2K | 1.46% |
| ROXANA BUSCHMAN3 Filed as: ROXANA BUSCHMAN AND OTHER AGENTS | 400 NE 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $784 | $0 | $784 | 0.56% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $303 | $0 | $303 | 0.22% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | $564 | $0 | $564 | 15.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | ZURICH AMERICAN INSURANCE COMPANY | $460 | $0 | $460 | 14.99% |
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 | 486 | 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) | 486 | 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 | 808 | $4.9M |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 808 | $4.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 431 | $262K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 431 | $262K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 431 | $262K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 808 | $4.9M |
| Other(5 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 486 | $408K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 808 | — |
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.