| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $28K | $2 | $28K | 1.98% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $0 | $8K | 9.71% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 15.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203026 DALLAS, TX 75320 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.46% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 1300 SW 5TH AVENUE, SUITE 500 PORTLAND, OR 97201 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $422 | $29 | $451 | 3.00% |
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 | 175 | 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) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 175 | $1.4M |
| Dental | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 175 | $1.4M |
| Vision | VISION SERVICE PLAN | 141 | $21K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $80K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 34 | $15K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $80K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 175 | $1.4M |
| Other(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.