| 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 | PACIFICSOURCE HEALTH PLANS | $48K | $0 | $48K | 3.22% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $10K | 15.22% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | WILLAMETTE DENTAL | $2K | $0 | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $896 | $0 | $896 | 5.01% |
| MARCI MARIE OTIS3 Filed as: MARCI OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $751 | $103 | $854 | 7.12% |
| CROL KENYON3 | 1645 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | AFLAC | $504 | $81 | $585 | 4.88% |
| TYLER M. OTIS3 Filed as: TYLER OTIS | 200 JULINA LANDE ROSEBURG, OR 97471 | AFLAC | $270 | $153 | $423 | 3.53% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURNACE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | AFLAC | $367 | $0 | $367 | 3.06% |
| JEROMY E. CILLEY3 Filed as: JEROMY CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | AFLAC | $277 | $59 | $336 | 2.80% |
| SHAWN M. OTIS3 Filed as: SHAWN OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $134 | $11 | $145 | 1.21% |
| PAIGE MARIE OTIS3 Filed as: PAIGE OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $64 | $0 | $64 | 0.53% |
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 | 114 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 212 | $1.5M |
| Dental | WILLAMETTE DENTAL | 100 | $46K |
| Vision | LIFEMAP ASSURANCE COMPANY | 123 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 289 | $68K |
| Short-term disability | AFLAC | 15 | $12K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 289 | $68K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 212 | $1.5M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 289 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 289 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.