| 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 | WILLAMETTE DENTAL INSURANCE, INC. | $1K | $0 | $1K | 2.17% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $3K | $937 | $3K | 15.98% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $565 | $278 | $843 | 7.92% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | AFLAC | $602 | $0 | $602 | 5.66% |
| CAROL A. KENYON3 | 1645 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | AFLAC | $528 | $0 | $528 | 4.96% |
| VINCENT BRIAN VOLLMAR3 | 777 COMMERCIAL STREET SE, SUITE 20 SALEM, OR 97301 | AFLAC | $141 | $0 | $141 | 1.32% |
| JEROMY E. CILLEY3 | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $115 | $0 | $115 | 1.08% |
| RICHARD E. SYFERT3 Filed as: RICHARD E. SUFERT | PO BOX 917 PLEASANT HILL, OR 97455 | AFLAC | $90 | $0 | $90 | 0.85% |
| RUSSELL JENSEN3 | 2452 NW HUMMINGBIRD DRIVE CORVALLIS, OR 97330 | AFLAC | $88 | $0 | $88 | 0.83% |
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 | 126 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 110 | $49K |
| Vision | LIFEMAP ASSURANCE COMPANY | 126 | $22K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 126 | $22K |
| Short-term disability | AFLAC | 7 | $11K |
| Other(3 contracts, 3 carriers) | LIFEMAP ASSURANCE COMPANY | 126 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.