| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | HEALTH NET | $17K | — | $17K | 2.38% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PRKWY #100 LAKE OSWEGA, OR 97035 | HEALTH NET | $4K | — | $4K | 0.56% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 700 NE MULTNOMAH SUITE 1300 PORTLAND, OR 97232 | AMERITAS LIFE INSURANCE CORP | $2K | — | $2K | 4.55% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST INC | 9811 KATY FWY SUITE 500 HOUSTON, TX 77024 | AMERITAS LIFE INSURANCE CORP | — | $454 | $454 | 0.93% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKWY 100 LAKE OSWEGO, OR 97035 | AMERITAS LIFE INSURANCE CORP | $312 | — | $312 | 0.64% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 825 NE MULTNOMAH ST SUITE 1500 PORTLAND, OR 97232 | VISION SERVICE PLAN | $561 | — | $561 | 5.52% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY SUITE 100 LAKE OSWEGO, OR 97035 | VISION SERVICE PLAN | $194 | — | $194 | 1.91% |
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 | 149 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 149 | $726K |
| Dental | AMERITAS LIFE INSURANCE CORP | 108 | $49K |
| Vision | VISION SERVICE PLAN | 85 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.