| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PROVIDENCE HEALTH PLAN | $28K | $0 | $28K | 2.85% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $6K | $0 | $6K | 9.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | WILLAMETTE DENTAL INSURANCE, INC. | $2K | $0 | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 12.04% |
| CONNEXION INSURANCE SOLUTIONS3 | 7001 220TH SW, MS 320 MOUNTLAKE TERRACE, WA 98043 | HARTFORD LIFE AND ACCIDENT | $0 | $1K | $1K | 5.56% |
| USI INSURANCE SERVICES LLC3 | 470 PARK AVENUE SOUTH, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | $0 | $23 | $23 | 0.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $561 | $0 | $561 | 5.00% |
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 | 158 | 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) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 291 | $977K |
| Dental(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 187 | $99K |
| Vision | LIFEMAP ASSURANCE COMPANY | 86 | $11K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 158 | $25K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 158 | $25K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 291 | $977K |
| Other | HARTFORD LIFE AND ACCIDENT | 158 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 291 | — |
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.