| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | TIMOTHY EDWARD HENNESSY PO BOX 1185 CORVALLIS, OR 97339 | PACIFICSOURCE HEALTH PLANS | $44K | — | $44K | 2.48% |
| GENE BISSINGER3 Filed as: GENE KIEL ASSOCIATES | 226 SW 7TH STREET CORVALLIS, OR 97333 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | — | $3K | 3.00% |
| GENE BISSINGER3 Filed as: GENE KIEL & ASSOCIATES | PO BOX 1185 CORVALLIS, OR 97339 | WILLAMETTE DENTAL GROUP | $2K | — | $2K | 4.54% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | PO BOX 1185 CORVALLIS, OR 97339 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 7.95% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | PO BOX 1185 CORVALLIS, OR 97339 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 13.07% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | 226 SW 7TH ST CORVALLIS, OR 97333 | VISION SERVICE PLAN | $870 | — | $870 | 6.50% |
| TIMOTHY HENNESSY3 Filed as: TIMOTHY E HENNESSY | PO BOX 1185 CORVALLIS, OR 97339 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 11.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFICSOURCE ADMINISTRATORS TPA | Claims processing Service code 12 | 13010 SW 68TH PKWY 300140934 TIGARD, OR 97223 | $4K |
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 | 218 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 210 | $1.8M |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 118 | $149K |
| Vision | VISION SERVICE PLAN | 209 | $13K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 218 | $11K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 216 | $32K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 218 | $24K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 210 | $1.8M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 218 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 218 | — |
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.