| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJI, INC. | PO BOX 847 MCMINNVILLE, OR 97128 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $123K | $3K | $125K | 4.02% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | HARTFORD LIFE AND ACCIDENT | $8K | $7K | $15K | 11.99% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | WILLAMETTE DENTAL INSURANCE, INC. | $4K | $0 | $4K | 5.41% |
| MJ INSURANCE3 Filed as: MJI, INC. | PO BOX 847 MCMINNVILLE, OR 97128 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | $0 | $2K | 5.31% |
| HAGAN HAMILTON INSURANCE3 | PO BOX 847 MCMINNVILLE, OR 97128 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $552 | $4K | 14.93% |
| MJ INSURANCE3 Filed as: MJI, INC. | PO BOX 847 MCMINNVILLE, OR 97128 | VISION SERVICE PLAN | $2K | $0 | $2K | 44.79% |
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 | 402 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 405 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 563 | $3.1M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 199 | $79K |
| Vision | VISION SERVICE PLAN | 295 | $4K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 416 | $125K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 416 | $125K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 563 | $3.1M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 416 | $191K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 563 | — |
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.