| 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 | $1K | $1K | 0.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $0 | $11K | 5.22% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $157 | $3K | 3.07% |
| 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 | $2K | $15 | $2K | 2.44% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $825 | $40 | $865 | 1.03% |
| KAREN CLAY KUNKLER3 | 415 SE 177TH AVENUE, UNIT 236 VANCOUVER, WA 98683 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $793 | $35 | $828 | 0.98% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $679 | $130 | $809 | 0.96% |
| ROXANA BUSCHMAN3 Filed as: ROXANA BUSCHMAN AND OTHER AGENTS | 400 NE 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $387 | $15 | $402 | 0.48% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $191 | $0 | $191 | 0.23% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | DELTA DENTAL OF COLORADO | $483 | $0 | $483 | 7.03% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES, INC. | 6143 SOUTH WILLOW DRIVE, SUITE 200 GREENWOOD VILLAGE, CO 80111 | DELTA DENTAL OF COLORADO | $275 | $0 | $275 | 4.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | DELTA DENTAL OF COLORADO | $257 | $0 | $257 | 3.74% |
| 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 | $299 | $0 | $299 | 15.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | DELTA DENTAL OF COLORADO | $171 | $0 | $171 | 10.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES, INC. | 6143 SOUTH WILLOW DRIVE, SUITE 200 GREENWOOD VILLAGE, CO 80111 | DELTA DENTAL OF COLORADO | $68 | $0 | $68 | 3.98% |
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 | 630 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 634 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 796 | $6.7M |
| Dental(2 contracts) | DELTA DENTAL OF COLORADO | 11 | $9K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 796 | $6.0M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 630 | $208K |
| Short-term disability(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 630 | $293K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 630 | $208K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 796 | $6.7M |
| Other(6 contracts, 6 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 630 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 796 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.