| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | PO BOX 745977 LOS ANGELES, CA 90074 | PACIFICSOURCE HEALTH PLANS | $28K | $1K | $29K | 1.88% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $19K | $0 | $19K | 1.23% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB ROAD, SUITE 340 EUGENE, OR 97401 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $486 | $2K | 3.73% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.45% |
| ALLIANT INSURANCE SERVICES, INC.3 | 18100 VON KARMAN AVENUE SUITE 1000 IRVINE, CA 92612 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $663 | $663 | 1.13% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | WILLAMETTE DENTAL INSURANCE, INC. | $920 | $0 | $920 | 3.25% |
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | UNKNOWN EUGENE, OR 97401 | WILLAMETTE DENTAL INSURANCE, INC. | $494 | $0 | $494 | 1.75% |
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 | 144 | 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) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 134 | $1.5M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $87K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $59K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 134 | $1.5M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 148 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.