| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | MODA, INC | $27K | — | $27K | 2.86% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 4.12% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | PO BOX 784 SPRINGFIELD, OR 97477 | HARTFORD LIFE AND ACCIDENT | $337 | — | $337 | 9.99% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 784 SPRINGFIELD, OR 97477 | STANDARD INSURANCE COMPANY | $147 | — | $147 | 4.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFICSOURCE ADMINISTRATORS INC EIN 30-0140934 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $2K |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA, INC | 287 | $953K |
| Dental | STANDARD INSURANCE COMPANY | 102 | $74K |
| Vision | STANDARD INSURANCE COMPANY | 102 | $3K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 119 | $3K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 119 | $3K |
| Prescription drug | MODA, INC | 287 | $953K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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.