| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | PACIFICSOURCE HEALTH PLANS | $317K | $0 | $317K | 2.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $154K | $262 | $154K | 2.82% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | WILLAMETTE DENTAL INSURANCE, INC. | $38K | $0 | $38K | 4.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $49K | $0 | $49K | 15.11% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | VISION SERVICE PLAN | $4K | $0 | $4K | 2.88% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $349 | $0 | $349 | 2.88% |
| MICHAEL S. MOLLOY3 | 1463 CAMP BAKER ROAD PHOENIX, OR 97535 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $141 | $0 | $141 | 1.16% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $57 | $0 | $57 | 0.47% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $48 | $0 | $48 | 0.40% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $46 | $0 | $46 | 0.38% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.21% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.11% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $862 | $1K | $2K | 18.84% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $135 | $1K | 11.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $829 | $28 | $857 | 7.58% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $316 | $356 | $672 | 5.94% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $315 | $190 | $505 | 4.47% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $469 | $185 | $654 | 5.79% |
| GORDON FREDERICK WOLLEN3 | PO BOX 846 CANNON BEACH, OR 97110 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $449 | $48 | $497 | 4.40% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $453 | $11 | $464 | 4.11% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $201 | $166 | $367 | 3.25% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $158 | $111 | $269 | 2.38% |
| GABRIEL ANGEL CANALS3 | 1329 NE 236TH AVENUE WOOD VILLAGE, OR 97060 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $18 | $27 | 0.24% |
| KAREN CLAY KUNKLER3 Filed as: KAREN CLAY KUNKLER AND OTHER AGENTS | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.09% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $159 | $119 | $278 | 7.11% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $162 | $4 | $166 | 4.24% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $142 | $15 | $157 | 4.01% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $38 | $91 | 2.33% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $16 | $54 | 1.38% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.18% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.15% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $174 | $214 | $388 | 12.68% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $209 | $4 | $213 | 6.96% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $59 | $119 | 3.89% |
| CHRISTINE LYNN MORGESTER3 | 988 SW 26TH STREET TOUTDALE, OR 97060 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $98 | $16 | $114 | 3.72% |
| ISAACSON INSURANCE AGENCY LLC3 Filed as: ISAACSON INSURANCE AGENCY, LLC | 1250 11TH STREET WEST LINN, OR 97068 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $81 | $21 | $102 | 3.33% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $55 | $26 | $81 | 2.65% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $50 | $0 | $50 | 2.31% |
| MICHAEL KIRKPATRICK3 | PO BOX 270 FREEDOM, CA 95050 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $48 | $0 | $48 | 2.22% |
| MICHAEL JAMES LEBRANE3 | 808 EAST 5TH AVENUE SAN MATEO, CA 94402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 1.48% |
| MARK TETSUO IWASAKI3 | 133 CRABAPPLE COURT HURCULES, CA 94547 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.60% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC AND OTHER AGENTS | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.46% |
| MICHAEL S. MOLLOY3 | 1463 CAMP BAKER ROAD PHOENIX, OR 97535 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.42% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.28% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $75 | $0 | $75 | 3.71% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 1.24% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.84% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.25% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.15% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.10% |
| ROXANA BUSCHMAN | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.10% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 3.55% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 2.25% |
| ROXANA BUSCHMAN | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 1.40% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.84% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.47% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 2.08% |
| MICHAEL S. MOLLOY3 | 1463 CAMP BAKER ROAD PHOENIX, OR 97535 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $0 | $18 | 1.70% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.57% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.19% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.19% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 2.37% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 1.44% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 1.13% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 1.13% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 2.52% |
| MICHAEL S. MOLLOY3 | 1463 CAMP BAKER ROAD PHOENIX, OR 97535 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 2.29% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.46% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.23% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.23% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 7.92% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 6.27% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 2.31% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 1.98% |
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 | 1,108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 1,248 | $16.1M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 1,625 | $785K |
| Vision(3 contracts, 3 carriers) | PACIFICSOURCE HEALTH PLANS | 1,328 | $16.2M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,108 | $322K |
| Prescription drug(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 1,248 | $16.1M |
| Other(14 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,108 | $376K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,625 | — |
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.