| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $30K | $0 | $30K | 1.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 749083 LOS ANGELES, CA 90074 | STANDARD INSURANCE COMPANY | $8K | $0 | $8K | 6.40% |
| BCI GROUP, INC.3 | UNKNOWN PORTLAND, OR 97230 | WILLAMETTE DENTAL INSURANCE, INC. | $3K | $0 | $3K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 307 OAK STREET HOOD RIVER, OR 97031 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $349 | $0 | $349 | 7.98% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $89 | $3 | $92 | 2.10% |
| HEARTEASE LLC3 | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $59 | $9 | $68 | 1.56% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $56 | $8 | $64 | 1.46% |
| PATRICK IAN WAGNER3 Filed as: PATRICK I. WAGNER AND OTHER AGENTS | 2232 HIGH COUNTRY DRIVE CARROLTON, TX 75007 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $56 | $1 | $57 | 1.30% |
| TIMOTHY J REED3 Filed as: TIMOTHY J. REED | 21 AZALEA DRIVE LUMBERTON, NJ 08048 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $46 | $0 | $46 | 1.05% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $7 | $33 | 0.75% |
| HISPTER ONCE LLC3 | 1665 NW HIGHLAND DRIVE CORVALLIS, OR 97330 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $43 | $0 | $43 | 5.80% |
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 | 200 | 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) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 237 | $1.6M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 237 | $1.7M |
| Vision | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 237 | $1.6M |
| Life insurance | STANDARD INSURANCE COMPANY | 200 | $120K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 200 | $125K |
| Long-term disability | STANDARD INSURANCE COMPANY | 200 | $120K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 237 | $1.6M |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 200 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 237 | — |
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.