| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | PO BOX 29 SPRINGFIELD, OR 97477 | PROVIDENCE HEALTH PLAN | $34K | $0 | $34K | 3.00% |
| UNKNOWN3 | UNKNOWN HALSEY, OR 97348 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $2K | $0 | $2K | 2.50% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $0 | $8K | 14.42% |
| UNKNOWN3 | UNKNOWN HALSEY, OR 97348 | MODA HEALTH | $701 | $0 | $701 | 2.50% |
| MELANIE KATE-MASON3 | PO BOX 906 PLEASANT HILL, OR 97455 | AFLAC | $1K | $45 | $1K | 8.96% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | AFLAC | $324 | $9 | $333 | 2.08% |
| MJ INSURANCE3 Filed as: SCOTT NIELSEN AND VARIOUS AGENTS | 7188 WEST FOURTH PLAN BOULEVARD VANCOUVER, WA 98660 | AFLAC | $258 | $0 | $258 | 1.61% |
| RICHARD G MCGOWAN3 Filed as: RICHARD MARK SUMMERS | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | AFLAC | $206 | $0 | $206 | 1.29% |
| PHILIP O MCGUIGAN3 | PO BOX 24021 EUGENE, OR 97402 | AFLAC | $115 | $9 | $124 | 0.77% |
| GUY R SOUTER3 Filed as: GUY SOUTER | 16280 PINE DROP LANE LA PINE, OR 97739 | AFLAC | $107 | $0 | $107 | 0.67% |
| SHARON DOUGLASS3 Filed as: SHARON C DOUGLASS | 702 PATROL STREET MOLALLA, OR 97038 | AFLAC | $81 | $0 | $81 | 0.51% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $809 | $0 | $809 | 6.00% |
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 | 135 | 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) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 99 | $1.1M |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 168 | $97K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 103 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $54K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $54K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $54K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 99 | $1.1M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.