| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJI, INC. DBA HAGAN HAMILTON INSURA | PO BOX 847 MCMINNVILLE, OR 97218 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $112K | $3K | $115K | 3.02% |
| MJ INSURANCE3 Filed as: MJI INC DBA HAGAN HAMILTON INS | PO BOX 847 MCMINNVILLE, OR 97128 | PRINCIPAL LIFE INSURANCE COMPANY | $20K | $6K | $26K | 13.95% |
| HAGAN HAMILTON INSURANCE3 Filed as: HAGAN-HAMILTON INSURANCE SERVICES | — | WILLAMETTE DENTAL INSURANCE, INC. | $4K | — | $4K | 5.00% |
| MJ INSURANCE3 Filed as: MJI, INC DBA HAGAN HAMILTON INS | PO BOX 847 MCMINNVILLE, OR 97128 | VISION SERVICE PLAN | $2K | — | $2K | 4.34% |
| DOUG A. SMITH3 Filed as: DOUG A SMITH | 2901 EAST 2ND STREET UNIT 60 NEWBERG, OR 97132 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $735 | — | $735 | 11.62% |
| MJ INSURANCE3 Filed as: MJI INC HAGAN HAMILTON INSURANCE | P.O. BOX 847 MCMINNVILLE, OH 97128 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $714 | — | $714 | 11.29% |
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 | 411 | 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) | 415 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 601 | $3.8M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 99 | $83K |
| Vision | VISION SERVICE PLAN | 339 | $35K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 408 | $188K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 408 | $188K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 408 | $194K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 601 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.