| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | $0 | $2K | 0.32% |
| CORRIE PERSING3 | PO BOX 663 MANZANITA, OR 97130 | AFLAC | $3K | $62 | $3K | 5.42% |
| VINCENT BRIAN VOLLMAR3 Filed as: VINCENT B. VOLLMAR AND OTHER AGENTS | 4085 HAGER STREET SE, SUITE 300 SALEM, OR 97317 | AFLAC | $2K | $32 | $2K | 3.89% |
| JASON PERKINS3 Filed as: JASON PERKINS, LLC | 1308 WEST SEASCAPE DRIVE GILBERT, AZ 85233 | AFLAC | $477 | $49 | $526 | 0.88% |
| ADRIAN ALLEN FUSI3 | PO BOX 6435 EUREKA, CA 95502 | AFLAC | $392 | $0 | $392 | 0.66% |
| DAVID LOVELL REID3 | 4924 CEDAR STREET ASTORIA, OR 97103 | AFLAC | $333 | $0 | $333 | 0.56% |
| VIRGINIA L KNOPSKI3 Filed as: VIRGINIA L. KNOPSKI | 3900 NE 97TH AVENUE VANCOUVER, WA 98662 | AFLAC | $206 | $0 | $206 | 0.35% |
| G SCOTT COOKE3 Filed as: SCOTT E. NIELSEN | 718B WEST FOURTH PLAIN BOULEVARD VANCOUVER, WA 98660 | AFLAC | $182 | $0 | $182 | 0.30% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $150 | $3K | 9.16% |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $686K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $746K |
| Vision(2 contracts, 2 carriers) | AFLAC | 158 | $88K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 158 | $88K |
| Short-term disability | AFLAC | 62 | $60K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $686K |
| Other | AFLAC | 62 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.