| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER & COMPANY INSURANCE | PO BOX 69508 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $37K | — | $37K | 3.00% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER & COMPANY INSURANCE | 5727 SW MACADAM AVE PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $690 | $8K | 6.49% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER & COMPANY INSURANCE | 5727 SW MACADAM AVE PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $138 | $2K | 6.28% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER & COMPANY INSURANCE | 5727 SW MACADAM AVE PORTLAND, OR 972393765 | VISION SERVICE PLAN | $862 | — | $862 | 5.57% |
| JD FULWILER AND COMPANY3 Filed as: JD FULWILER & COMPANY INSURANCE | PO BOX 69508 PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 14.03% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $130 | $1K | 11.85% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $54 | $1K | 11.07% |
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 | 167 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 74 | $15K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $30K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 202 | $135K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 202 | $126K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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.