| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | PROVIDENCE HEALTH PLAN | $29K | $0 | $29K | 3.00% |
| THE PARTNERS GROUP3 | 11740 SW 68TH PKWY, STE 200 PORTLAND, OR 97223 | VISION SERVICE PLAN | $771 | $0 | $771 | 7.28% |
| J.L. JONES AND ASSOCIATES3 Filed as: JL JONES AND ASSOCIATES | 720 COUNTRY CLUB RD EUGENE, OR 97401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $409 | $0 | $409 | 10.00% |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 115 | $950K |
| Dental | MODA HEALTH PLANS, INC | 0 | $80K |
| Vision | VISION SERVICE PLAN | 109 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $4K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 159 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.