| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON, INC. | 1325 4TH AVENUE, SUITE 1705 SEATTLE, WA 98101 | PACIFICSOURCE HEALTH PLANS | $73K | $0 | $73K | 3.07% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON, INC. | 2106 PACIFIC AVENUE, SUITE 501 TACOMA, WA 98402 | PACIFICSOURCE HEALTH PLANS | $0 | $3K | $3K | 0.13% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON, INC. | 701 5TH AVENUE, SUITE 550 SEATTLE, WA 98101 | HARTFORD LIFE AND ACCIDENT | $12K | $0 | $12K | 10.55% |
| BROWN AND BROWN OF FLORIDA, INC.3 | 100 RIALTO PLACE, SUITE 900 MELBOURNE, FL 32901 | HARTFORD LIFE AND ACCIDENT | $0 | $4K | $4K | 3.28% |
| THE PARTNERS GROUP3 Filed as: THE PARTNERS GROUP, LLC | 11850 SW 67TH AVENUE, SUITE 100 PORTLAND, OR 97223 | HARTFORD LIFE AND ACCIDENT | -$30 | $0 | -$30 | -0.03% |
| KATE THOMAS GROUP INC3 Filed as: KATE THOMAS GROUP, INC. | 1201 NW WALL STREET, SUITE 100 BEND, OR 97703 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 10.55% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF WASHINGTON, INC. | 2106 PACIFIC AVENUE, SUITE 501 TACOMA, WA 98402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 4.05% |
| RYAN GEORGE KRUIT3 | 612 GLENEDEN PLACE BEND, OR 97702 | CONTINENTAL AMERICAN INSURANCE COMPANY | $831 | $0 | $831 | 2.28% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF OREGON, INC. | 2701 NW VAUGHN STREET, SUITE 340 PORTLAND, OR 97210 | CONTINENTAL AMERICAN INSURANCE COMPANY | $747 | $0 | $747 | 2.05% |
| JAMES S SARANTIS3 Filed as: JAMES STEPHEN SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $538 | $0 | $538 | 1.48% |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 250 | $2.4M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 192 | $109K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 192 | $109K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 192 | $109K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 250 | $2.4M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 192 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.