| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | PACIFICSOURCE HEALTH PLANS | $237K | — | $237K | 3.05% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $121K | — | $121K | 2.51% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $25K | — | $25K | 0.52% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | WILLAMETTE DENTAL INSURANCE, INC. | $32K | — | $32K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $37K | $5K | $42K | 17.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | VISION SERVICE PLAN | $3K | — | $3K | 3.00% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $566 | $2K | 3.92% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 3.59% |
| MJ INSURANCE3 Filed as: KAREN C. KUNKLER AND VARIOUS AGENTS | 1709 NW 45TH AVENUE CMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $55 | $1K | 3.19% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 806 NW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $504 | $327 | $831 | 1.94% |
| CHRISTINE LYNN MORGESTER3 | 9405 NE 100TH WAY VANCOUVER, WA 98662 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $586 | $143 | $729 | 1.70% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $368 | $183 | $551 | 1.28% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $367 | $5 | $372 | 0.87% |
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 | 928 | 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) | 928 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 1,300 | $12.6M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 1,419 | $5.4M |
| Vision | VISION SERVICE PLAN | 1,181 | $101K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 928 | $249K |
| Prescription drug(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 1,300 | $12.6M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 928 | $296K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,419 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.