| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | PROVIDENCE HEALTH PLANS | $17K | — | $17K | 1.83% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | SECURIAN LIFE INSURANCE COMPANY | $3K | — | $3K | 4.68% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 15.77% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | VISION SERVICE PLAN | $949 | — | $949 | 6.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CASCADE CENTERS INC EIN 93-0774210 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $4K |
| POLESTAR BENEFITS INC EIN 20-2371430 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $630 |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 74 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLANS | 161 | $911K |
| Dental | SECURIAN LIFE INSURANCE COMPANY | 115 | $66K |
| Vision | VISION SERVICE PLAN | 119 | $15K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $26K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 161 | — |
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.