| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUMPHREY & PACE BENEFIT PLANNING3 | 700 E MAIN STREET, STE 107 MEDFORD, OR 97504 | PROVIDENCE HEALTH PLAN | $37K | — | $37K | 2.75% |
| HUMPHREY & PACE BENEFIT PLANNING3 | 700 E MAIN STREET, STE 107 MEDFORD, OR 97504 | GUARDIAN | $7K | — | $7K | 10.82% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | — | $2K | 49.42% |
| OREGON AUTOMOBILE DEALER4 | 7357 SW BEVELAND STREET SUITE 200 TIGARD, OR 97223 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $160 | $160 | 3.24% |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 114 | $1.4M |
| Dental | GUARDIAN | 173 | $68K |
| Vision | GUARDIAN | 173 | $68K |
| Life insurance | GUARDIAN | 173 | $68K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 173 | $73K |
| Long-term disability(2 contracts, 2 carriers) | GUARDIAN | 173 | $73K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 114 | $1.4M |
| Other(2 contracts, 2 carriers) | GUARDIAN | 173 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.