| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAMPBELL GALT AND NEWLANDS, INC.3 | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | HEALTH NET | $17K | — | $17K | 2.02% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | HEALTH NET | $8K | — | $8K | 0.98% |
| MARY ESTHER TAYLOR3 | 1126 GATEWAY LOOP SPRINGFIELD, OR 97477 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 6.68% |
| CAMPBELL GAIT AND NEWLANDS, INC.3 Filed as: CAMPBELL GALT AND MEWLANDS INC. | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $884 | — | $884 | 2.30% |
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $672 | — | $672 | 1.75% |
| RITA J ROBINSON3 Filed as: RITA J. ROBINSON | 21780 WILLAMETTE DRIVE WEST LINN, OR 97068 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $324 | $89 | $413 | 1.07% |
| MJ INSURANCE3 Filed as: PREMIER WORKSITE AND VARIOUS AGENTS | 806 MW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $331 | $42 | $373 | 0.97% |
| BECKET MOORE WRIGHT3 | PO BOX 2982 CLACKAMUS, OR 97015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $251 | — | $251 | 0.65% |
| BDAMON RAY OGIER3 | 731 BROOKSIDE CIRCLE ROGUE RIVER, OR 97537 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $96 | — | $96 | 0.25% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | WILLAMETTE DENTAL INSURANCE, INC. | $479 | — | $479 | 2.50% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $850 | — | $850 | 5.09% |
| CAMPBELL GALT AND NEWLANDS, INC.3 | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | LIFEMAP ASSURANCE COMPANY | $483 | — | $483 | 2.89% |
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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 142 | $818K |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 58 | $19K |
| Vision | LIFEMAP ASSURANCE COMPANY | 151 | $17K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 151 | $55K |
| Prescription drug | HEALTH NET | 142 | $818K |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 151 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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.