| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19K | $18K | $38K | 24.26% |
| JULIE WOLDEN3 Filed as: JULIE WOLDEN AND OTHER AGENTS | 2231 LARCH STREET LONGVIEW, WA 98632 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19K | $4K | $23K | 14.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $2K | $14K | 9.25% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $7K | $11K | 7.09% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $3K | $10K | 6.22% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $5K | $9K | 5.98% |
| ISAACSON INSURANCE AGENCY LLC3 Filed as: ISAACSON INSURANCE AGENCY, LLC | 1250 11TH STREET WEST LINN, OR 97068 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $2K | $8K | 5.07% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $6K | $12K | 20.90% |
| RAQUEL LOSADA MONROY3 Filed as: RAQUEL LOSADA MONROY AND AGENTS | 817 NE DELP ROAD CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $1K | $7K | 12.62% |
| KYM ELIZABETH DUNHAM3 | 828 SAFFLOWER COURT HENDERSON, NV 89015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $967 | $5K | 8.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $683 | $4K | 7.29% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $2K | $4K | 6.56% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 6.12% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $3K | 5.50% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $981 | $2K | 19.61% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOL, INC. & AGENTS | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $792 | $441 | $1K | 12.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $629 | $124 | $753 | 7.34% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $252 | $470 | $722 | 7.04% |
| ISAACSON INSURANCE AGENCY LLC3 Filed as: ISAACSON INSURANCE AGENCY, LLC | 1250 11TH STREET WEST LINN, OR 97068 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $475 | $135 | $610 | 5.94% |
| TROY DARWIN GIFFORD3 | 5369 NORTH ISLA AVENUE MERIDIAN, ID 83646 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $574 | $12 | $586 | 5.71% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $377 | $200 | $577 | 5.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | $0 | $6 | 0.09% |
| BRYAN P. JORAMO3 | 1001 LOMBARD AVENUE EVERETT, WA 98201 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | $0 | $5 | 0.08% |
| ADAM J. WESTFALL3 | 700 NORTH HAYDEN ISLAND DRIVE SUITE 200 PORTLAND, OR 97217 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| NATE JOHNSON3 | 11328 NE 51ST CIRCLE, APARTMENT 65 VANCOUVER, WA 98682 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| DEREK SOMMERS3 Filed as: DEREK W. SOMMERS | 518 NORTH 39TH PLACE RIDGEFIELD, WA 98642 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| TERESA BLAKE3 Filed as: TERESA A. BLAKE AND OTHER AGENTS | 3408 CANTURA BLUFF AVENUE NORTH LAS VEGAS, NV 89031 | AFLAC | $194 | $0 | $194 | 5.54% |
| THOMAS CHAMBERS3 | 490 24TH STREET NE SALEM, OR 97301 | AFLAC | $86 | $0 | $86 | 2.46% |
| DAVID J MCCLELLAN3 Filed as: DAVID HERRERA | 1325 SHADY GROVE ROAD ELKLAND, MO 65644 | AFLAC | $69 | $0 | $69 | 1.97% |
| ADAM J. WESTFALL3 Filed as: ADAM JAMES WESTFALL | 2713 SW WILLOW PARKWAY GRESHAM, OR 97080 | AFLAC | $41 | $0 | $41 | 1.17% |
| KEVIN C HALLAM3 Filed as: KEVIN C. HALLAM | 2145 HYACINTH DRIVE BILLINGS, MT 59105 | AFLAC | $30 | $0 | $30 | 0.86% |
| AHMAD GHODS3 | 20048 SW 56TH AVENUE TUALATIN, OR 97062 | AFLAC | $25 | $0 | $25 | 0.71% |
| NATE JOHNSON3 | 11328 NE 51ST CIRCLE APARTMENT 65 VANCOUVER, WA 98682 | AFLAC | $25 | $0 | $25 | 0.71% |
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 | 429 | 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) | 429 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 429 | $3.9M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC | 160 | $55K |
| Vision | VISION SERVICE PLAN | 308 | $54K |
| Life insurance(3 contracts) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $223K |
| Short-term disability(4 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $230K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 429 | $3.9M |
| Other(5 contracts, 3 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $233K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 429 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.