| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOB HART INSURANCE INC3 | 321 SE I STREET GRANTS PASS, OR 97526 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $23K | — | $23K | 2.12% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $637 | $4K | 8.91% |
| HART INSURANCE3 Filed as: HART INSURANCE AGENCY | PO BOX 1240 GRANTS PASS, OR 97528 | WILLAMETTE DENTAL GROUP | $2K | — | $2K | 5.00% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $187 | $3K | 15.96% |
| JOHN E FRALICH3 Filed as: JOHN FRALICH | 321 SE I STREET GRANTS PASS, OR 97526 | UNITED HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $169 | $2K | 11.26% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $164 | $2K | 16.54% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | AMERITAS LIFE INSURANCE CORP. | $632 | — | $632 | 9.99% |
| BOB HART INSURANCE INC3 | PO BOX 1240 GRANTS PASS, OR 97528 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $924 | $148 | $1K | 17.41% |
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 | 242 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 152 | $1.1M |
| Dental(2 contracts, 2 carriers) | WILLAMETTE DENTAL GROUP | 211 | $44K |
| Vision | UNITED HERITAGE LIFE INSURANCE COMPANY | 129 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 242 | $13K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 242 | $39K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 152 | $1.1M |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 242 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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.