| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WALTZ SHERIDAN CRAWFORD INC.3 Filed as: WALTZ SHERIDAN CRAWFORD, INC. | P.O. BOX 128 FOREST GROVE, OR 97116 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $106K | $8K | $114K | 2.42% |
| WALTZ SHERIDAN CRAWFORD INC.3 Filed as: WALTZ SHERIDAN CRAWFORD | P.O. BOX 128 FOREST GROVE, OR 97116 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 8.20% |
| WALTZ SHERIDAN CRAWFORD INC.3 Filed as: WALTZ SHERIDAN CRAWFORD | P.O. BOX 128 FOREST GROVE, OR 97116 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 7.89% |
| WALTZ SHERIDAN CRAWFORD INC.3 Filed as: WALTZ SHERIDAN CRAWFORD | P.O. BOX 128 FOREST GROVE, OR 97116 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 18.42% |
| WALTZ SHERIDAN CRAWFORD INC.3 Filed as: WALTZ SHERIDAN CRAWFORD | P.O. BOX 128 FOREST GROVE, OR 97116 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $670 | — | $670 | 27.19% |
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 | 456 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 457 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 905 | $4.7M |
| Dental | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 905 | $4.7M |
| Vision | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 905 | $4.7M |
| Life insurance(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 465 | $148K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 465 | $146K |
| Long-term disability(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 465 | $162K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 465 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 905 | — |
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.