| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.L. JONES AND ASSOCIATES3 | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.40% |
| SVEND NILSSON3 Filed as: SVEND NELSON | 1220 JACOBS DRIVE EUGENE, OR 97402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $257 | $0 | $257 | 1.59% |
| JEFFREY JONES3 Filed as: JEFFREY LEE JONES | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $229 | $0 | $229 | 1.42% |
| MICHAEL S. MOLLOY3 Filed as: MICHAEL S. MALLOY | 1463 CAMP BAKER ROAD PHOENIX, OR 97535 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $124 | $0 | $124 | 0.77% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $75 | $0 | $75 | 0.47% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 0.27% |
| ROXANNA BUSCHMAN3 | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.24% |
| MJ INSURANCE3 Filed as: DAMON RAY OGIER AND VARIOUS AGENTS | 1630 CARNAHAN DRIVE, APARTMENT 5 GRANTS PASS, OR 97527 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.20% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 35 | $16K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 181 | $26K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 181 | $26K |
| Prescription drug | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 35 | $16K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 181 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.