| 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 | $49K | $0 | $49K | 3.49% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $3K | $11K | 17.05% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | WILLAMETTE DENTAL INSURANCE, INC. | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $861 | $0 | $861 | 5.01% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $445 | $4 | $449 | 4.72% |
| CAROL A. KENYON3 | 1645 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | AFLAC | $251 | $7 | $258 | 2.71% |
| JEROMY E. CILLEY3 | 1115 PEARL STREET EUGENE, OR 97401 | AFLAC | $152 | $3 | $155 | 1.63% |
| TYLER M. OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $139 | $0 | $139 | 1.46% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | AFLAC | $125 | $0 | $125 | 1.31% |
| SHAWN M. OTIS3 Filed as: SHAWN MICHAEL OTIS AND OTHER AGENTS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $28 | $5 | $33 | 0.35% |
| RICHARD G MCGOWAN3 Filed as: RICHARD MARK SUMMERS | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | AFLAC | $13 | $0 | $13 | 0.14% |
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 | 123 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 206 | $1.4M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 109 | $51K |
| Vision | LIFEMAP ASSURANCE COMPANY | 125 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $65K |
| Short-term disability | AFLAC | 10 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $65K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 206 | $1.4M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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.